Rituximab seems a promising therapeutic option in granulomatosis with polyangiitis with intestinal perforation: a case report and literature review

Dag, Muhammet Sait; Pehlıvan, Yavuz; Tutar, Ediz; Kısacık, Bünyamin

doi:10.1136/bcr-2012-007518

Cited by 10 publications

(6 citation statements)

References 14 publications

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“…A combination of surgery and immunosuppressant therapy is crucial to control intestinal ischaemia due to vasculitis. Glucocorticoids and cyclophosphamide are commonly used to treat GPA; however, some patients are resistant to these standard therapies 2. We present the case of a Japanese man who had been undergoing maintenance haemodialysis and who had two severe episodes of peritonitis despite standard therapy.…”

Section: Introductionmentioning

confidence: 99%

Granulomatosis with polyangiitis with intestinal involvement successfully treated with rituximab and surgery

et al. 2019

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Intestinal perforation is a rare and life-threatening complication in granulomatosis with polyangiitis (GPA). A 55-year-old Japanese man who had been undergoing maintenance haemodialysis was diagnosed with GPA via a pathologically proven nasal granuloma and proteinase 3-antineutrophil cytoplasmic antibody-positive status. He was started on 60 mg prednisolone. Haematochezia was observed due to the colon ulcer after treatment initiation. Two doses of intravenous cyclophosphamide were administered every 2 weeks. Despite the treatment, there were two episodes of severe abdominal pain with peritonitis within a week. Perforation of descending colon and severe ischaemia of the ascending colon was observed during each emergency laparotomy, and ileostomy was performed. Vasculitis in the small vessels was confirmed. In conclusion, patient with severe intestinal involvement and who was unresponsive to conventional therapy was treated with surgery followed by rituximab administration, and remission was achieved.

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Section: Introductionmentioning

confidence: 99%

Granulomatosis with polyangiitis with intestinal involvement successfully treated with rituximab and surgery

et al. 2019

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“…A risk of perforation was also noted in patients receiving IL-2 after therapy with ipilimumab [65] . In addition, rituximab, a novel monoclonal antibody agent used as a therapeutic option to deplete B-lymphocyte populations, was used to reportedly treat multiple distal ileal perforations in a patient with Wegener's granulomatosis [66] . A number of reports, noted above, have also recorded rare cases of free perforation in CD following anti-tumor necrosis factor (TNF) monoclonal antibody treatment [15][16][17] .…”

Section: Medication-related Causesmentioning

confidence: 99%

Spontaneous free perforation of the small intestine in adults

Freeman¹

2014

WJG

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“…In 2008, a Wegner patient resistant to conventional therapies was reported, who achieved partial remission following four doses of 500 mg RTX, which hampered pulmonary worsening [ 48 ]. Years later, the successful treatment of more complicated GPA patients, such as refractory GPA associated with several different clinical manifestations, including scleritis [ 49 , 50 , 51 , 52 , 53 ], orbital involvement [ 54 , 55 , 56 ], intestinal perforation [ 57 ], massive intracerebral hemorrhage [ 58 ], meningeal involvement [ 59 , 60 ], peripheral ulcerative keratitis (PUK) [ 61 , 62 ], and subglottic stenosis [ 63 ] were reported. Several case series reported GPA patients treated with RTX based on the lymphoma protocol [ 64 , 65 , 66 , 67 , 68 , 69 ]; however, one study showed that RTX is not associated with clinical and serological refractory GPA improvement [ 70 ].…”

Section: Resultsmentioning

confidence: 99%

The Efficacy and Safety of Rituximab in ANCA-Associated Vasculitis: A Systematic Review

Habibi

Alesaeidi

Zahedi

et al. 2022

Biology

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Background and aim: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare multisystem autoimmune disease developed by autoantibody production against human neutrophilic granulocytes, including proteinase-3 (PR3) and myeloperoxidase (MPO). The management of AAV patients is difficult due to the multiorgan involvement, high rate of relapse, and complications of immunosuppressive agents that make it challenging. This study aims to investigate the efficacy and safety of rituximab (RTX) therapy in patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) subtypes. Method: The PubMed/Medline database was searched for any studies related to RTX therapy in ANCA-associated vasculitis (GPA and MPA subtypes), from inception to 1 August 2022, and proceeded in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Our search resulted in 1082 initial records. After the elimination of review papers, irrelevant studies, and non-English records, 223 articles were included, and the data related to the efficacy and safety of RTX therapy were extracted. Several randomized and non-randomized studies showed that RTX is an effective treatment option for patients with AAV. Most of the studies showed the very effective effect of RTX in controlling disease in AAV patients, including pediatrics, adults, and elderlies, although RTX cannot completely prevent relapse. However, maintenance therapy helps delay the disease’s relapse and causes sustained remission. Not only the licensed dose (375 mg/m2 intravenous per week for 4 weeks) could induce disease remission, but studies also showed that a single infusion of RTX could be effective. Although RTX could resolve many rare manifestations in AAV patients, there are few reports showing treatment failure. Additionally, few sudies have reported the unexpeted worsening of the disease after RTX administration. Generally, RTX is relatively safe compared to conventional therapies, but some serious adverse effects, mainly infections, cytopenia, hypogammaglobinemia, malignancy, and hypersensitivity have been reported. Conclusions: RTX is an effective and relatively safe therapeutic option for AAV. Studies on the evaluation of the safety profiles of RTX and the prevention of severe RTX-related side effects in AAV patients are required.

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Rituximab seems a promising therapeutic option in granulomatosis with polyangiitis with intestinal perforation: a case report and literature review

Cited by 10 publications

References 14 publications

Granulomatosis with polyangiitis with intestinal involvement successfully treated with rituximab and surgery

Granulomatosis with polyangiitis with intestinal involvement successfully treated with rituximab and surgery

Spontaneous free perforation of the small intestine in adults

The Efficacy and Safety of Rituximab in ANCA-Associated Vasculitis: A Systematic Review

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