NDT Advance Access originally published online on January 20, 2007
Nephrology Dialysis Transplantation 2007 22(3):959; doi:10.1093/ndt/gfm001
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Reply
Email: chriswong{at}doctors.org.ukSir,
We thank Dr Sanchez-Cano et al. for this letter. However, we believe that the authors have misinterpreted the statement, ‘granulomatous disease seems more likely to be resistant to rituximab (RIT) than vasculitis’ in our article published in this journal [1]. The statement actually compared and referred to Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) patients with active glomerulonephritis and alveolar haemorrhage (vasculitis), described by Keogh et al. [2] and Stasi et al. [3], as opposed to the more prominent granulomatous manifestations, in particular the retro-orbital granulomas, described in patients studied by Aries et al. [4] and Omdal et al. [5]. The former group of patients responded better and remained in remission as compared to the latter. Treatment of refractory granulomas of the upper respiratory tract and lungs with RIT has been well described by other authors [2–4,6–8]. We concluded in our article that in WG, patients with retro-orbital granulomas tend to be less responsive to RIT. This suggests that response to RIT may depend on the disease manifestation. The last statement by the authors also compliments our conclusion that RIT seems to be effective treatment in patients with refractory ANCA-associated vasculitis (AAV), both in WG and MPA. However, randomised controlled trials are needed to evaluate the efficacy of RIT in AAV before it can be considered a standard treatment.
Conflict of interest statement. None declared.
Department of Nephrology
University Hospital Aintree
Lower Lane, Liverpool, L9 7AL, UK
References
- Wong CF. Rituximab in refractory antineutrophil cytoplasmic antibody associated vasculitis: what is the current evidence? Nephrol Dial Transplant [Epub 7 November].
[Abstract/Free Full Text] - Keogh KA, Ytterberg SR, Fervenza FC, Carlson KA, Schroeder DR, Specks U. (2006) Rituximab for refractory Wegener's granulomatosis: report of a prospective, open label pilot trial. Am J Respir Crit Care Med 173:180–187.
[Abstract/Free Full Text] - Stasi R, Stipa E, Del Poeta G, Amadori S, Newland AC, Provan D. (2006) Long-term observation of patients with antineutrophil cytoplasmic antibody-associated vasculitis treated with Rituximab. Rheumatology 45:1432–1436.
[Abstract/Free Full Text] - Aries PM, Hellmich B, Both M, et al. (2006) Lack of efficacy of rituximab in Wegener's granulomatosis with refractory granulomatous manifestation. Ann Rheum Dis 65:853–858.
[Abstract/Free Full Text] - Omdal R, Wildhagen K, Hansen T, Gunnarson R, Kristoffersen G. (2005) Anti-CD20 therapy of treatment-resistant Wegener's granulomatosis: favourable but temporary response. Scand J Rheumatol 34:229–232.[CrossRef][ISI][Medline]
- Cheung CM, Murray PI, Savage CO. (2005) Successful treatment of Wegener's granulomatosis associated scleritis with rituximab. Br J Ophthalmol 89:1542.
[Free Full Text] - Kallenbach M, Duan H, Ring T. (2005) Rituximab induced remission in a patient with Wegener's granulomatosis. Nephron Clin Pract 99:92–96.
- Eriksson P. (2005) Nine patients with anti-neutrophil cytoplasmic antibody-positive vasculitis successfully treated with rituximab. J Intern Med 257:540–548.[CrossRef][ISI][Medline]
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