Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis

Guillevin, Loı̈c; Pagnoux, Christian; Karras, Alexandre; Khouatra, C.; Aumaître, O.; Cohen, Pascal; Maurier, F.; Decaux, Olivier; Ninet, J.; Gobert, P.; Quéméneur, T.; Blanchard-Delaunay, Claire; Godmer, Pascal; Puéchal, Xavier; Carron, Pierre-Louis; Hatron, Pierre‐Yves; Limal, Nicolas; Hamidou, M.; Ducret, M.; Daugas, Éric; Papo, Thomas; Bonnotte, Bernard; Mahr, Alfred; Ravaud, Philippe; Mouthon, Luc

doi:10.1056/nejmoa1404231

Cited by 907 publications

(593 citation statements)

References 29 publications

(24 reference statements)

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“…Rituximab was the first chimeric molecule developed to treat B cell nonHodgkin lymphomas (10). Its use was then extended to autoimmune anemia, rheumatic diseases (11,12) and, more recently, antibody-mediated conditions affecting the kidney, including ANCA-associated vasculitis (13) and membranous GN (14). Upon binding, the complex rituximab-CD20 is translocated into the lipid raft of the cell membrane, where it crossreacts with sphigomyelin phosphodieterase acid-like 3b protein (SMPDL-3b) (9).…”

Section: Anti-cd20 Antibodies: Specificity and Mechanism Of Actionmentioning

confidence: 99%

Anti-CD20 Antibodies for Idiopathic Nephrotic Syndrome in Children

Ravani

Bonanni²,

Rossi³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Rituximab, a chimeric anti-CD20 monoclonal antibody originally licensed for lymphoma, is emerging as a novel steroid-sparing agent for idiopathic nephrotic syndrome in children. The potential use of anti-CD20 monoclonal antibodies in idiopathic nephrotic syndrome has contributed to shifting the view of podocytopathies from T cellmediated to more complex immunomediated disorders that can benefit from targeting B cells and other mediators of the early immune response. Clinical data on the use of rituximab also have implications on disease management and classification. In this review, we present results of clinical studies that support rituximab as an effective steroid-sparing agent in steroid-dependent idiopathic nephrotic syndrome. Recent randomized controlled trials suggest that potential benefits of rituximab therapy in steroid-dependent forms of idiopathic nephrotic syndrome vary depending on whether children are dependent on steroids alone or on both steroids and calcineurin inhibitors, with greater probabilities to achieve drug-free remission in the former group. Multiple-drug dependence may identify a different disease state with different prognosis and treatment options. Insufficient data are available on optimal use of rituximab as a maintenance steroid-sparing agent in these steroid-sensitive forms of the disease, including how often and for how long rituximab infusions should be repeated to maximize expected benefits and minimize potential harms. Finally, one randomized controlled trial in children with steroid-resistant idiopathic nephrotic syndrome yielded negative results. New anti-CD20 antibodies are under study in this patient population.

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Section: Anti-cd20 Antibodies: Specificity and Mechanism Of Actionmentioning

confidence: 99%

Anti-CD20 Antibodies for Idiopathic Nephrotic Syndrome in Children

Ravani

Bonanni²,

Rossi³

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…WEGENTStudie [179]. Auch die remissionserhaltende Behandlung mit RTX nach Induktion mit CYC wurde gemäß Studienprotokoll nicht später als 4 Wochen nach der letzten CYC-Gabe begonnen [68].…”

Section: Remissionserhaltende Therapie Nach Induktion Mit Cyclophosphunclassified

“…In den zulassungsrelevanten Studien für RTX bei AAV wurde RTX (ohne eine zusätzliche remissionserhaltende Therapie) mit einer Induktionsbehandlung mit CYC, gefolgt von einer remissionserhaltenden Therapie mit AZA, verglichen [111,112,218,226] [68].…”

Section: Remissionserhaltende Therapie Nach Induktion Mit Rituximabunclassified

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

Schirmer

Moosig²

2017

Z Rheumatol

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“…Some patients in our study had sustained remission after discontinuation of IVIG, as previously described (10), but IVIG seemed to exhibit only a suspension of disease activity in a minority of patients (11%), who had a relapse within the first 6 months following IVIG discontinuation. Given its high cost and the emergence of new effective maintenance treatment, in particular rituximab (25), prolonged IVIG therapy should probably be avoided in clinical practice. We cannot, however, exclude the possibility that some patients with refractory disease and/or reduced immunoglobulin levels could benefit from the combination strategy of IVIG at immunomodulating doses plus rituximab, which might improve the response rate or decrease the risk of infections.…”

Section: Crickx Et Almentioning

confidence: 99%

Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody–Associated Vasculitides: A French Nationwide Study of Ninety‐Two Patients

Crickx

Machelart

Lazaro

et al. 2016

Arthritis & Rheumatology

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Objective. Intravenous immunoglobulin (IVIG) represents a therapeutic alternative in antineutrophil cytoplasmic antibody-associated vasculitides (AAV), but its efficacy has been evaluated in only 2 small prospective trials. The aim of this study was to evaluate the efficacy and safety of IVIG in patients with AAV.Methods. We conducted a nationwide retrospective study of patients who received IVIG as immunomodulatory therapy for AAV.Results. A total of 92 patients (mean age 51 years) presenting with either granulomatosis with polyangiitis (Wegener's) (68%), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (22%), or microscopic polyangiitis (10%) received at least 1 course of IVIG. Antineutrophil cytoplasmic antibodies were present in 72% during the flare that required IVIG, as determined by immunofluorescence assay. IVIG was initiated because of relapsing disease in 83% of cases. IVIG was given for a median of 6 months (range 1-156 months) and in combination with corticosteroids in 21% of the patients or with other immunosuppressive agents in 77%. Efficacy of IVIG was assessed in the entire population and in a subset of 34 patients with unmodified background therapy. Remission rates at 6 months were 56% in the entire pop-

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Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis

Abstract: More patients with ANCA-associated vasculitides had sustained remission at month 28 with rituximab than with azathioprine. (Funded by the French Ministry of Health; MAINRITSAN ClinicalTrials.gov number, NCT00748644; EudraCT number, 2008-002846-51.).

Cited by 907 publications

References 29 publications

Anti-CD20 Antibodies for Idiopathic Nephrotic Syndrome in Children

Anti-CD20 Antibodies for Idiopathic Nephrotic Syndrome in Children

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

Intravenous Immunoglobulin as an Immunomodulating Agent in Antineutrophil Cytoplasmic Antibody–Associated Vasculitides: A French Nationwide Study of Ninety‐Two Patients

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