NDT Advance Access published online on August 6, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn430
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Rituximab as rescue therapy in anti-neutrophil cytoplasmic antibody-associated vasculitis: single centre experience with 15 patients
1 Department of Nephrology, Hannover Medical School, Hannover, Germany 2 Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK 3 Department of Hemostasis, Oncology and Stem Cell Transplantation 4 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
Correspondence and offprint requests to: Marion Haubitz, Division of Nephrology, Department of Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Tel: +49-511-5326319; Fax: +49-511-552366; E-mail: Haubitz.Marion{at}MH-Hannover.de
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Abstract |
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Background. B-cell depletion with rituximab, a chimeric anti-CD20 antibody, is a novel treatment for refractory and relapsing ANCA-associated small-vessel vasculitis. Data are limited and most reports describe single patients or small numbers of patients followed prospectively.
Methods. We report a single-centre experience with 15 patients who received rituximab for refractory or relapsing ANCA-associated vasculitis. All patients had been treated with corticosteroids and cyclophosphamide and a variety of other second-line immunosuppressive agents. None of the patients had evidence of infection and received four infusions of 375 mg/m2 of rituximab. Disease activity was assessed in accordance with the Birmingham Vasculitis Activity Score (BVAS). BVAS, C-reactive protein and ANCA titres were recorded at baseline and during follow-up.
Results. B-cell depletion was achieved in all patients. Partial or complete remission was seen in 14 of 15 patients with a significant decline in BVAS compared to baseline (P < 0.007). One patient with granulomatous ANCA-associated vasculitis did not respond to rituximab. There were no side effects during rituximab infusion. Transient leucopenia was observed in two patients. One patient with bronchial stenosis died of pneumonia 5.5 months after the initiation of rituximab treatment. One initially anti-HBc-positive/HBsAg-negative patient experienced a reactivation of hepatitis B, developed end-stage renal failure and died after refusal of dialysis.
Conclusions. We report the largest case series of rituximab use for ANCA-associated vasculitis so far. Our data support that the drug is capable of inducing partial or complete remission in refractory or relapsing patients. Leucopenia and infectious complications remain a matter of concern.
Keywords: ANCA-associated vasculitis; B-cell depletion; rituximab
Received for publication: 16.12.07
Accepted in revised form: 4. 7.08