Rituximab plus methotrexate combination as a salvage therapy in persistently active granulomatosis with polyangiitis
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissionsoup.com..
OBJECTIVE: The aim of this study was to describe the efficacy and safety of rituximab and MTX (RTX/MTX) combination therapy in ANCA-associated vasculitides (AAV).
METHODS: A retrospective French nationwide study was conducted in patients with AAV who received RTX/MTX combination therapy for persistently active disease.
RESULTS: Seventeen patients were included. All patients had granulomatosis with polyangiitis (GPA), with positive ANCA in 76% of them, mainly with PR3-ANCA specificity. Sixteen patients (94%) had priorly failed to achieve remission with RTX and 11 (65%) with CYC. Patients had experienced a median of 3 (2-4) flares. Manifestations requiring RTX/MTX combination therapy were subglottic or bronchial stenosis in 6 patients (35%), orbital mass in 6 (35%), disabling ENT involvement in 2 (12%), and epiduritis and pachymeningitis in 1 case (6%) each. The median follow-up duration for the RTX/MTX combination therapy was 11 months (11-26 months). At 6 months, global response had been achieved in 15 patients (88%), including partial response in 11 (65%) and complete response in 4 (24%). At last evaluation, global response had been achieved in 16 patients (94%). Seven patients (41%) experienced severe adverse events (grade 3 or 4), including infections in 4 (24%) and hepatitis in 2 (12%). Combination therapy was withdrawn in 4 patients (24%), but never for safety concerns. In contrast, the MTX dose was decreased in 2 patients (12%) because of adverse events. One patient died of an unknown cause.
CONCLUSION: RTX/MTX combination therapy could be an effective salvage therapy to treat persistently active GPA with granulomatous manifestations, with an acceptable safety profile.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:61 |
|---|---|
| Enthalten in: |
Rheumatology (Oxford, England) - 61(2022), 6 vom: 30. Mai, Seite 2619-2624 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Sorin, Boris [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
4F4X42SYQ6 |
|---|
| Anmerkungen: |
Date Completed 02.06.2022 Date Revised 09.06.2022 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1093/rheumatology/keab791 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM332388735 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM332388735 | ||
| 003 | DE-627 | ||
| 005 | 20231225215455.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1093/rheumatology/keab791 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1107.xml |
| 035 | |a (DE-627)NLM332388735 | ||
| 035 | |a (NLM)34698818 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sorin, Boris |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Rituximab plus methotrexate combination as a salvage therapy in persistently active granulomatosis with polyangiitis |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 02.06.2022 | ||
| 500 | |a Date Revised 09.06.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a OBJECTIVE: The aim of this study was to describe the efficacy and safety of rituximab and MTX (RTX/MTX) combination therapy in ANCA-associated vasculitides (AAV) | ||
| 520 | |a METHODS: A retrospective French nationwide study was conducted in patients with AAV who received RTX/MTX combination therapy for persistently active disease | ||
| 520 | |a RESULTS: Seventeen patients were included. All patients had granulomatosis with polyangiitis (GPA), with positive ANCA in 76% of them, mainly with PR3-ANCA specificity. Sixteen patients (94%) had priorly failed to achieve remission with RTX and 11 (65%) with CYC. Patients had experienced a median of 3 (2-4) flares. Manifestations requiring RTX/MTX combination therapy were subglottic or bronchial stenosis in 6 patients (35%), orbital mass in 6 (35%), disabling ENT involvement in 2 (12%), and epiduritis and pachymeningitis in 1 case (6%) each. The median follow-up duration for the RTX/MTX combination therapy was 11 months (11-26 months). At 6 months, global response had been achieved in 15 patients (88%), including partial response in 11 (65%) and complete response in 4 (24%). At last evaluation, global response had been achieved in 16 patients (94%). Seven patients (41%) experienced severe adverse events (grade 3 or 4), including infections in 4 (24%) and hepatitis in 2 (12%). Combination therapy was withdrawn in 4 patients (24%), but never for safety concerns. In contrast, the MTX dose was decreased in 2 patients (12%) because of adverse events. One patient died of an unknown cause | ||
| 520 | |a CONCLUSION: RTX/MTX combination therapy could be an effective salvage therapy to treat persistently active GPA with granulomatous manifestations, with an acceptable safety profile | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ANCA | |
| 650 | 4 | |a granulomatosis with polyangiitis | |
| 650 | 4 | |a methotrexate | |
| 650 | 4 | |a rituximab | |
| 650 | 7 | |a Antibodies, Antineutrophil Cytoplasmic |2 NLM | |
| 650 | 7 | |a Rituximab |2 NLM | |
| 650 | 7 | |a 4F4X42SYQ6 |2 NLM | |
| 650 | 7 | |a Methotrexate |2 NLM | |
| 650 | 7 | |a YL5FZ2Y5U1 |2 NLM | |
| 700 | 1 | |a Samson, Maxime |e verfasserin |4 aut | |
| 700 | 1 | |a Durel, Cécile-Audrey |e verfasserin |4 aut | |
| 700 | 1 | |a Diot, Elisabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Guichard, Isabelle |e verfasserin |4 aut | |
| 700 | 1 | |a Grados, Aurélie |e verfasserin |4 aut | |
| 700 | 1 | |a Limal, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Régent, Alexis |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, Pascal |e verfasserin |4 aut | |
| 700 | 1 | |a Dion, Jérémie |e verfasserin |4 aut | |
| 700 | 1 | |a Legendre, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Le Guern, Véronique |e verfasserin |4 aut | |
| 700 | 1 | |a Mouthon, Luc |e verfasserin |4 aut | |
| 700 | 1 | |a Guillevin, Loïc |e verfasserin |4 aut | |
| 700 | 1 | |a Terrier, Benjamin |e verfasserin |4 aut | |
| 700 | 0 | |a French Vasculitis Study Group (FVSG) |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Rheumatology (Oxford, England) |d 1999 |g 61(2022), 6 vom: 30. Mai, Seite 2619-2624 |w (DE-627)NLM102581908 |x 1462-0332 |7 nnns |
| 773 | 1 | 8 | |g volume:61 |g year:2022 |g number:6 |g day:30 |g month:05 |g pages:2619-2624 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1093/rheumatology/keab791 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 61 |j 2022 |e 6 |b 30 |c 05 |h 2619-2624 | ||