338. Rituximab maintenance therapy in relapsing ANCA-associated vasculitis
Creators: name: Satrapová1, Veronika
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives: </strong>Rituximab (RTX, an anti-CD20 monoclonal antibody) is now used both as an induction and maintenance treatment of ANCA-associated vasculitis (AAV). Several maintenance therapy regimens are used and the optimal treatment management is still discussed. The aim of this study was to review our single-centre experience with the use of RTX in this indication, focused on the long-term prognosis of patients after rituximab withdrawal. <strong>Methods: </strong>Maintenance treatment with RTX has been routinely used in all AAV patients with induction RTX treatment (2x1g after 14 days) started after relapse at our department since 2009. RTX was administered preemptively according to the protocol in scheduled intervals (1 gram every 6 months for a total treatment period of 2 years). Basic clinical and laboratory data were evaluated, including examination of humoral and cellular immunity, at 0-3-6 months and then every 6 months. <strong>Results: </strong>Rituximab maintenance treatment was initiated in 55 patients with relapsing AAV from January 2009 to December 2018. 34 patients have already completed the therapeutic regimen (28 patients according to the standard protocol, in 6 patients the therapy was extended by 1-2 gra of RTX), 20 patients terminated treatment prematurely (reasons: leaving for renal transplantation or progression to ESKD in 5 patients, insufficient response in 1 patient, stable remission in 8 patients, non-compliance in 2 patients, side effects in 1 patient, new malignancy in 1 patient and death in 2 patients), 1 patient continues the treatment. RTX maintenance therapy was generally well tolerated, with no or only mild side effects, most commonly infectious complications. Hypogammaglobulinaemia below 7 g/l was reported in 33 % of patients, while severe hypogammaglobulinaemia less than 3 g/l was reported in only 2 %. In 34 patients (M / F 18/16, median age 43.5 years, PR3/MPO-ANCA 31/3) who completed the RTX treatment, the median follow-up was 57 (range 12-126) months. The median duration of B cell depletion after the last RTX dose was 11 months, the median dose of prednisone at the time of the last RTX was 2.5 mg/day and at the end of follow-up 2 mg/day. ANCA levels were mostly (77 % of patients) negative at the end of the scheduled therapy. A total of 17 patients (50 %) developed relapse during subsequent follow-up, the median time to relapse was 20 months after the last RTX dose, with a wide variety. The relapse was treated with RTX re-induction therapy in 82 %, with azathioprine in 12 % and with only corticosteroids in 6 %. <strong>Conclusions: </strong>Our study confirmed that RTX is a well-tolerated and effective maintenance treatment for the patients with relapsing AAV. Treatment leads to a long-term stable remission with the opportunity to a dose reduction or discontinuation of corticosteroids, however, despite previous RTX treatment many of the patients still relapse after therapy withawal. <strong>Disclosures:</strong> None