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NDT Advance Access published online on October 20, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl573
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received August 15, 2006
Accepted August 25, 2006

Original Article

Rituximab in refractory antineutrophil cytoplasmic antibody associated vasculitis: what is the current evidence?

Christopher Wong 1 *

1 Department of Nephrology, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK

* To whom correspondence should be addressed.
Christopher Wong, E-mail: chriswong{at}doctors.org.uk



  Abstract

Background. Antineutrophil cytoplasmic antibody associated vasculitis (AAV) is recognized as a chronic, relapsing and potentially fatal disease. Cyclophosphamide and steroids remain the mainstay of treatment of AAV. Unfortunately, in up to 10% of patients, disease remains refractory despite conventional therapy. In addition, conventional therapy has some serious side effects and hence limits its long-term use. For these refractory patients and those intolerant of conventional therapy, there are limited therapeutic options. B-lymphocytes have been implicated in the pathogenesis of AAV. Rituximab (RIT) is a chimeric monoclonal anti-CD20 antibody, which depletes B-lymphocytes and has been proposed as salvage therapy for refractory disease.

Methods. We review the literature to evaluate the current evidence for the use of RIT in inducing remission in patients with refractory AAV.

Conclusions. RIT seems to be effective treatment in patients with refractory AAV. In Wegener's granulomatosis, patients with retro-orbital granulomas tend to be less responsive to RIT. We proposed that a multicentre randomized controlled trial of AAV patients receiving RIT and prednisolone is required to evaluate the efficacy in inducing remission.

Keywords: ANCA-associated vasculitis; evidence; rituximab.
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