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Rituximab use in patients with ANCA-associated vasculitis: clinical efficacy and impact on immunological parameters

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Abstract

Rituximab (RTX) was reported effective in ANCA-associated vasculitis (AAV). We aimed to evaluate clinical efficacy of RTX in AAV along with its impact on immunological parameters. Eighteen RTX-treated AAV patients (M/F 11/7; median age 37.5; 15× PR3-ANCA, 3× MPO-ANCA; 16× relapsing/refractory, 2× first-line therapy) were enrolled. Clinical response, ANCA, total serum IgG levels and cellular immunity parameters were examined. The patients were followed up (FU) for a median of 26 months (range 3–82, 15 for ≥6 months). All patients achieved B cell depletion (lasting 3–24 months). No significant increase was noted in T cell or NK cell subpopulations. At 6 months, partial remission was achieved in 5/15 patients (33 %) and complete in 8 (53 %). The median prednisone dose (30..10 mg/d) and ANCA levels (17.2..2.7 IU/mL) decreased (p < 0.01). RTX retreatment was used in nine (8× pre-emptive, 1× relapse). Six patients relapsed (none of the pre-emptively treated). Three patients died of infection. IgG levels at 3 months decreased compared to baseline (9.0 vs 5.7 g/L, p < 0.01). Higher percentage of HLA-DR+CD3+ cells and lower percentage of CD4+CD45RA+ naive T cells persisted during FU. IFN-γ production increased at 6 months compared to baseline (27.3 vs 41.5 %). No significant change was noted in the intracellular IL-10 and IL-12 production. RTX helped to lower the glucocorticosteroids dose and withdraw cytotoxic drugs in most AAV patients. Hypogammaglobulinaemia was common but well tolerated. Peripheral circulating T cells remained activated despite B cell depletion.

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Acknowledgments

This study was supported by PRVOUK-P25/LF1/2, GAUK-442611, 2013.

Conflict of interest

Authors Chocova Z, Hruskova Z, Mareckova H, Svobodova B, Duskova D, Bednarova V, Jancova E and Rysava R declare that they have no conflict of interest. Prof. Tesar received honoraria from Roche.

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Authors and Affiliations

  1. Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, U nemocnice 2, 128 08, Prague, Czech Republic

    Z. Chocova, Z. Hruskova, B. Svobodova, V. Bednarova, E. Jancova, R. Rysava & V. Tesar

  2. Institute of Immunology and Microbiology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

    Z. Hruskova & H. Mareckova

  3. 1st Department of Medicine—Clinical Department of Haematology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

    D. Duskova

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  1. Z. Chocova
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  2. Z. Hruskova
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  3. H. Mareckova
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  4. B. Svobodova
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  5. D. Duskova
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  6. V. Bednarova
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  7. E. Jancova
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  8. R. Rysava
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  9. V. Tesar
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Correspondence to Z. Chocova.

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Chocova, Z., Hruskova, Z., Mareckova, H. et al. Rituximab use in patients with ANCA-associated vasculitis: clinical efficacy and impact on immunological parameters. Clin Rheumatol 34, 107–115 (2015). https://doi.org/10.1007/s10067-014-2816-7

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  • DOI: https://doi.org/10.1007/s10067-014-2816-7

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