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Experience with similar biologic rituximab in 77 patients of granulomatosis with polyangiitis—a real-life experience

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Abstract

Objectives

To present single centre experience on the efficacy and safety of similar biologic of rituximab in patients with granulomatosis with polyangiitis (GPA).

Methods

This was a retrospective study of GPA patients who received similar biologic of rituximab as either remission induction or maintenance agent. Demographic parameters, Birmingham Vasculitis Activity Score (BVAS-v3), vasculitis damage index, relapse and adverse events were retrieved from patient records. Outcomes noted were remission at 6 months in remission induction group and rates of relapses, adverse events, serious infections and mortality in both remission induction and maintenance groups.

Results

Seventy-seven GPA patients were enrolled. Sixty received rituximab for induction and 57 for maintenance; 69% were anti PR-3 positive. In the induction group, median BVAS-v3 reduced from 12 (IQR 6–21.5) to 0 (0–1) at 6 months. At 6 months, 60% patients attained remission, 40% in primary induction group and 74% in re-induction group (p = 0.016%). In the maintenance group, seven (12%) patients had relapses with median time to relapse of 12 (6–22) months. Median relapse free survival was 21 (6–22) months on rituximab maintenance. There were 12 deaths (15.6%) and 18 serious infections.

Conclusion

Similar biologic of rituximab was an effective agent for remission induction and remission maintenance in patients with GPA. Head to head trials with innovator molecule are needed to confirm these results.

Key Points:

• Remission was achieved in 60% of GPA patients who received similar biologic of rituximab as remission induction therapy.

• Relapse rate during maintenance phase was 12% with similar biologic of rituximab. Serious infections and mortality with similar biologic of rituximab were comparable with that reported previously in AAV trials.

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Authors and Affiliations

  1. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Sakshi Mittal, G. S. R. S. N. K. Naidu, Saket Jha, Varun Dhir, Sanjay Jain & Aman Sharma

  2. Department of Nephrology, PGIMER,, Chandigarh, India

    Manish Rathi

  3. Department of Histopathology, PGIMER, Chandigarh, India

    Ritambhra Nada

  4. Department of Immunopathology, PGIMER, Chandigarh, India

    Ranjana W Minz

  5. Department of Medical Microbiology, PGIMER, Chandigarh, India

    Kusum Sharma

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  1. Sakshi Mittal
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  2. G. S. R. S. N. K. Naidu
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Correspondence to Aman Sharma.

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Mittal, S., Naidu, G.S.R.S.N.K., Jha, S. et al. Experience with similar biologic rituximab in 77 patients of granulomatosis with polyangiitis—a real-life experience. Clin Rheumatol 40, 645–651 (2021). https://doi.org/10.1007/s10067-020-05261-7

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  • DOI: https://doi.org/10.1007/s10067-020-05261-7

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