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Rituximab in the treatment of refractory scleritis in patients with granulomatosis with polyangiitis (Wegener’s)

  • Inflammatory Disorders
  • Published:
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Abstract

Purpose

The purpose of this descriptive study was to evaluate the clinical response to rituximab (RTX) in patients with scleritis due to granulomatosis with polyangiitis (GPA), in patients who had proved refractory to treatment with systemic glucocorticoids and immunosuppressive agents.

Methods

Retrospective analysis of interventional case series. Single referral center study. Eight patients (12 affected eyes) due to scleritis secondary to GPA, refractory to conventional treatment were included to receive RTX as therapy for remission induction. RTX was administered as a 1-g infusion every 2 weeks, for a total of 2 g. Patient follow-up included clinical evaluation (systemic and ophthalmologic), B-cell subset (CD19, CD20, CD22) counts, proteinase-3 anti-neutrophil cytoplasmic antibody (PR-3 ANCA), and Birmingham Vasculitis Activity Score for Wegener's granulomatosis (BVAS-WG). Outcomes were response to treatment and achievement of remission, as well as number of ocular relapses.

Results

The main indication for treatment was refractory necrotising anterior scleritis. Four weeks after completion of treatment with RTX, all patients showed clear clinical improvement, with no further progression. In all patients, an absolute depletion of B cells was confirmed in the first 6 weeks after treatment. Seven patients (87.5 %) achieved remission of inflammatory activity in 7 months or less. However, three patients experienced ocular relapse, which comprised reactivation of the anterior scleritis, uveitis, and posterior scleritis, and two patients required a second dose of RTX, with immediate improvement.

Conclusions

RTX is useful in the treatment of refractory necrotising scleritis in patients with GPA. Of note, in those who relapse after remission, RTX can be successfully used for retreatment.

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Acknowledgments

Roche Mexico provided rituximab as compassionate treatment for seven of the eight patients.

This work was presented in part at the 2013 annual meeting of the Association for Research in Vision and Ophthalmology (ARVO).

Author information

Authors and Affiliations

  1. Ophthalmology, Instituto Nacional de Ciencias Medicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico

    Claudia Recillas-Gispert

  2. Instituto de Oftalmologia “Conde de Valenciana”, Mexico City, Mexico

    Juan Carlos Serna-Ojeda

  3. Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502. Col. Sección XVI, C.P. 14080, Mexico City, Mexico

    Luis Felipe Flores-Suárez

Authors
  1. Claudia Recillas-Gispert
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  2. Juan Carlos Serna-Ojeda
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  3. Luis Felipe Flores-Suárez
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Corresponding author

Correspondence to Luis Felipe Flores-Suárez.

Ethics declarations

Ethical approval

This study was approved by the local ethics committee. Informed consent was obtained from all patients for RTX administration. All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments.

Author contributions

Design of the study: CRG and LFFS. Conduct of the study CRG and LFFS. Collection, management, and analysis of the data: JCSO, LFFS. Interpretation of the data: CRG, JCSO and LFFS. Preparation, review, or approval of the manuscript: JCSO, CRG and LFFS.

Conflict of interest statement

Drs. Recillas-Gispert and Serna-Ojeda certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Dr. Flores-Suárez served as consultant for Roche Mexico and discloses having received honoraria (less than 1000 USD) and having provided expert opinion and participation in national licensing approval of the drug of study for its indication in the treatment for remission induction of ANCA-associated vasculitis at the Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS), Mexico.

Financial disclosures

Claudia Recillas-Gispert: no commercial relationship. Juan Carlos Serna-Ojeda: no commercial relationship. Luis Felipe Flores-Suárez: Roche Mexico: Code C (consultant).

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Recillas-Gispert, C., Serna-Ojeda, J.C. & Flores-Suárez, L.F. Rituximab in the treatment of refractory scleritis in patients with granulomatosis with polyangiitis (Wegener’s). Graefes Arch Clin Exp Ophthalmol 253, 2279–2284 (2015). https://doi.org/10.1007/s00417-015-3198-5

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  • DOI: https://doi.org/10.1007/s00417-015-3198-5

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