Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Smith Rona M, Jones Rachel Bronwen, Specks Ulrich, Bond Simon, Nodale Marianna, Aljayyousi Reem, Andrews Jacqueline, Bruchfeld Annette, Camilleri Brian, Carette Simon, Cheung Chee Kay, Derebail Vimal, Doulton Tim, Forbess Lindsy, Fujimoto Shouichi, Furuta Shunsuke, Gewurz-Singer Ora, Harper Lorraine, Ito-Ihara Toshiko, Khalidi Nader, Klocke Rainer, Koening Curry, Komagata Yoshinori, Langford Carol, Lanyon Peter, Luqmani Raashid Ahmed, Makino Hirofumi, McAlear Carole A, Monach Paul, Moreland Larry W, Mynard Kim, Nachman Patrick, Pagnoux Christian, Pearce Fiona, Peh Chen Au, Pusey Charles, Ranganathan Dwarakanathan, Rhee Rennie L, Spiera Robert, Sreih Antoine G, Tesar Vladimir, Walters Giles, Weisman Michael H, Wroe Caroline, Merkel Peter A, Jayne David, RITAZAREM coinvestigators, RITAZAREM co-investigators
Аннотация
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.