Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis
Creators: name: Smith, Rona M
name: Jones, Rachel Bronwen
name: Specks, Ulrich
name: Bond, Simon
name: Nodale, Marianna
name: Aljayyousi, Reem
name: Andrews, Jacqueline
name: Bruchfeld, Annette
name: Camilleri, Brian
name: Carette, Simon
name: Cheung, Chee Kay
name: Derebail, Vimal
name: Doulton, Tim
name: Forbess, Lindsy
name: Fujimoto, Shouichi
name: Furuta, Shunsuke
name: Gewurz-Singer, Ora
name: Harper, Lorraine
name: Ito-Ihara, Toshiko
name: Khalidi, Nader
name: Klocke, Rainer
name: Koening, Curry
name: Komagata, Yoshinori
name: Langford, Carol
name: Lanyon, Peter
name: Luqmani, Raashid Ahmed
name: Makino, Hirofumi
name: McAlear, Carole
name: Monach, Paul
name: Moreland, Larry W
name: Mynard, Kim
name: Nachman, Patrick
name: Pagnoux, Christian
name: Pearce, Fiona
name: Peh, Chen Au
name: Pusey, Charles
name: Ranganathan, Dwarakanathan
name: Rhee, Rennie L
name: Spiera, Robert
name: Sreih, Antoine G
name: Tesar, Vladimir
name: Walters, Giles
name: Weisman, Michael H
name: Wroe, Caroline
name: Merkel, Peter
name: Jayne, David
name: RITAZAREM Co-Investigators
name: Arimura, Y
name: Clarkson, M
name: De Zoysa, J
name: Endo, T
name: Hamano, Y
name: Kono, H
name: Lawman, S
name: Muso, E
name: Sada, K
name: Smith, R
name: Suzuki, K
name: Tsukamoto, T
name: Uchida, S
name: Vaglio, A
name: Watts, R
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Vasculitis
1506
2311
2508
B cells
granulomatosis with polyangiitis
treatment
systemic vasculitis

description: Funder: Research Committee on Intractable Vasculitides; The Ministry of Health, Labour and Welfare of Japan.
description: Objectives: Evaluation of rituximab and glucocorticoids as therapy to induce remission after relapse in ANCA-associated vasculitis (AAV) in a prospective observational cohort of patients enrolled into the induction phase of the RITAZAREM trial. Methods: Patients relapsing with granulomatosis with polyangiitis or microscopic polyangiitis were prospectively enrolled and received remission-induction therapy with rituximab (4×375 mg/m2) and a higher or lower dose glucocorticoid regimen, depending on physician choice: reducing from either 1 mg/kg/day or 0.5 mg/kg/day to 10 mg/day by 4 months. Patients in this cohort achieving remission were subsequently randomised to receive one of two regimens to prevent relapse. Results: 188 patients were studied: 95/188 (51%) men, median age 59 years (range 19–89), prior disease duration 5.0 years (range 0.4–34.5). 149/188 (79%) had previously received cyclophosphamide and 67/188 (36%) rituximab. 119/188 (63%) of relapses had at least one major disease activity item, and 54/188 (29%) received the higher dose glucocorticoid regimen. 171/188 (90%) patients achieved remission by 4 months. Only six patients (3.2% of the study population) did not achieve disease control at month 4. Four patients died in the induction phase due to pneumonia (2), cerebrovascular accident (1), and active vasculitis (1). 41 severe adverse events occurred in 27 patients, including 13 severe infections. Conclusions: This large prospective cohort of patients with relapsing AAV treated with rituximab in conjunction with glucocorticoids demonstrated a high level of efficacy for the reinduction of remission in patients with AAV who have relapsed, with a similar safety profile to previous studies.