Long-term efficacy and safety of pre-emptive maintenance therapy with rituximab in Granulomatosis with Polyangiitis: Results from a single centre

Besada, Emilio; Koldingsnes, Wenche; Nossent, Jiri

doi:10.1016/j.lpm.2013.02.298

Cited by 19 publications

(24 citation statements)

References 17 publications

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“…An alternative approach is to use pre-emptive treatment either based on reconstitution of B cells or fixed intervals 6 7. However, flares in the absence of peripheral B lymphocyte have been observed in the former8 while the latter may lead to hypogammaglobulinaemia and serious infection 9 10. Alternatively, low-dose rituximab (500 mg) can be given every 6 months as per MAINRITSAN regimen, although the comparative long term of this approach is not yet known 11.…”

Section: Introductionmentioning

confidence: 99%

Repeat cycles of rituximab on clinical relapse in ANCA-associated vasculitis: identifying B cell biomarkers for relapse to guide retreatment decisions

et al. 2015

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Objective: To assess clinical and B cell biomarkers to predict relapse after rituximab in ANCA-associated vasculitis (AAV) using retreatment on clinical relapse strategy.Methods: 35 patients with AAV received treatment with 2x1000mg rituximab, repeated on clinical relapse (up to 5 cycles). Disease activity was assessed by Birmingham Vasculitis Activity Score and peripheral B cell subsets using highly sensitive flow cytometry (HSFC) as previously described; both performed at baseline and every 3 months.Results: Response rates were high: >83%, with median time-to-relapse of 82 weeks for Cycle 1 (C1) and >54 weeks for all cycles. Prior to rituximab, AAV was characterised by naïve B-lymphopenia compared to healthy controls. This dysregulation was more marked in patients with raised CRP (p<0.05). In C1, no clinical feature predicted relapse. However, repopulation of naïve B cell at 6 months was associated with a reduced risk of relapse (HR: 0.326, 95% 0.114-0.930, p=0.036). Relapse rates at 12 and 18 months were 0% and 14% with naïve repopulation at 6 months, and 31% and 54% without naïve repopulation.

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Section: Introductionmentioning

confidence: 99%

Repeat cycles of rituximab on clinical relapse in ANCA-associated vasculitis: identifying B cell biomarkers for relapse to guide retreatment decisions

et al. 2015

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“…Other studies did not find an increased general infection risk in RA patients [25]. In patients with vasculitides that have low IgG levels after treatment with rituximab, an increased infection risk has been reported [40,41]. This is not confirmed by other studies, although antibiotic prophylaxis may have reduced the infection frequency in these hypogammaglobulinemic patients [42].…”

Section: Strong Immunosuppressantsmentioning

confidence: 88%

“…These patients include adults and children with various autoimmune diseases, including SLE, autoimmune hemolytic anemia and autoimmune vasculitis. Most reports on symptomatic hypogammaglobulinemia do not elaborate on the effect of antibody replacement therapy on infection frequency or IgG levels [40,41,70,71].…”

Section: Antibody Replacement Therapy In Ihgmentioning

confidence: 99%

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Antibody replacement therapy in primary antibody deficiencies and iatrogenic hypogammaglobulinemia

Hoffman

Kessel

Velzen‐Blad

et al. 2015

Expert Review of Clinical Immunology

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Antibody replacement therapy has been used in the treatment of primary antibody deficiencies (PADs) for several decades, and an evidence-based guideline for its treatment is currently available. By contrast, the use of antibody replacement therapy in iatrogenic hypogammaglobulinemia (IHG), a condition that is associated with immunosuppressive medication, has hardly any evidence base and no guidelines. As IHG can be equally as severe as PAD and is much more prevalent, evidence-based guidelines are urgently needed. This review will focus on the differences and similarities between PAD and IHG and the use of antibody replacement therapy in both conditions. Suggestions for the development of evidence-based guidelines and future research are given.

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“…Successful use of rituximab as a remission maintenance agent has been described in several large case series but so far has not been formally tested in a randomized controlled trial against any of the usual oral agents [111][112][113][114][115]. Although the drug was reported to be generally well tolerated serious infectious adverse events were not uncommon, although many of the patients had large cumulative doses of cyclophosphamide before administration of rituximab.…”

Section: Maintenance Therapymentioning

confidence: 99%

Evidence-based therapy for the ANCA-associated vasculitides: what do the trials show so far?

Dyall

Chanouzas²,

Morgan³

2014

Clinical Investigation

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Anti-neutrophil cytoplasm antibody-associated vasculitides are rare multisystem inflammatory diseases including granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. Previously these diseases were almost universally fatal, however, with current therapy 5-year survival for microscopic polyangiitis and granulomatosis with polyangiitis is approximately 80%. This review discusses the recent randomized controlled trials and other studies that have driven the improvement in survival and also highlights treatment-related morbidity and areas of unmet need in the management of anti-neutrophil cytoplasm antibody-associated vasculitides.

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Long-term efficacy and safety of pre-emptive maintenance therapy with rituximab in Granulomatosis with Polyangiitis: Results from a single centre

Cited by 19 publications

References 17 publications

Repeat cycles of rituximab on clinical relapse in ANCA-associated vasculitis: identifying B cell biomarkers for relapse to guide retreatment decisions

Repeat cycles of rituximab on clinical relapse in ANCA-associated vasculitis: identifying B cell biomarkers for relapse to guide retreatment decisions

Antibody replacement therapy in primary antibody deficiencies and iatrogenic hypogammaglobulinemia

Evidence-based therapy for the ANCA-associated vasculitides: what do the trials show so far?

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