Sustained post-rituximab B-cell depletion is common in ANCA-associated vasculitis and is affected by sex and renal function
© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA..
OBJECTIVE: Despite the increasing use of rituximab in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), it remains unclear what the optimal dosing is, especially for maintenance of remission. A deeper understanding of post-rituximab B-cell repopulation patterns may aid better-tailored treatment.
METHODS: This is a monocentric, retrospective study including ANCA-positive AAV patients receiving a single course of rituximab induction. CD19+ B cells were longitudinally monitored with flow cytometry. B-cell repopulation was defined as CD19+ >10 cells/μL.
RESULTS: Seventy-one patients were included, the majority with microscopic polyangiitis (75%), myeloperoxidase-ANCA positivity (75%) and with renal involvement (79%). During a median follow-up of 54 months since the first rituximab infusion, 44 patients (62%) repopulated B cells, with a median time to repopulation of 39 months (range 7-102). Patients experiencing B-cell depletion lasting longer than the overall median time to repopulation (39 months) exhibited a lower risk of flare and higher risk of serious infection. In multivariate Cox regression, higher estimated glomerular filtration rate (eGFR) [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.13-2.98 per 30 mL/min/1.73 m2 eGFR] and female sex (HR 2.70, 95% CI 1.37-5.31) were independent predictors of increased rate of B-cell repopulation.
CONCLUSION: A subset of AAV patients develop sustained post-rituximab B-cell depletion, which associates with reduced risk of flare and increased risk of serious infection in the long term. Preserved renal function and female sex are associated with faster B-cell repopulation. These observations further highlight the need to personalize immunosuppression to improve clinical outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association - 39(2024), 4 vom: 27. März, Seite 683-693 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mescia, Federica [VerfasserIn] |
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| Links: |
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| Themen: |
4F4X42SYQ6 |
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| Anmerkungen: |
Date Completed 28.03.2024 Date Revised 28.03.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/ndt/gfad197 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Sustained post-rituximab B-cell depletion is common in ANCA-associated vasculitis and is affected by sex and renal function |
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| 500 | |a Date Revised 28.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. | ||
| 520 | |a OBJECTIVE: Despite the increasing use of rituximab in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), it remains unclear what the optimal dosing is, especially for maintenance of remission. A deeper understanding of post-rituximab B-cell repopulation patterns may aid better-tailored treatment | ||
| 520 | |a METHODS: This is a monocentric, retrospective study including ANCA-positive AAV patients receiving a single course of rituximab induction. CD19+ B cells were longitudinally monitored with flow cytometry. B-cell repopulation was defined as CD19+ >10 cells/μL | ||
| 520 | |a RESULTS: Seventy-one patients were included, the majority with microscopic polyangiitis (75%), myeloperoxidase-ANCA positivity (75%) and with renal involvement (79%). During a median follow-up of 54 months since the first rituximab infusion, 44 patients (62%) repopulated B cells, with a median time to repopulation of 39 months (range 7-102). Patients experiencing B-cell depletion lasting longer than the overall median time to repopulation (39 months) exhibited a lower risk of flare and higher risk of serious infection. In multivariate Cox regression, higher estimated glomerular filtration rate (eGFR) [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.13-2.98 per 30 mL/min/1.73 m2 eGFR] and female sex (HR 2.70, 95% CI 1.37-5.31) were independent predictors of increased rate of B-cell repopulation | ||
| 520 | |a CONCLUSION: A subset of AAV patients develop sustained post-rituximab B-cell depletion, which associates with reduced risk of flare and increased risk of serious infection in the long term. Preserved renal function and female sex are associated with faster B-cell repopulation. These observations further highlight the need to personalize immunosuppression to improve clinical outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ANCA | |
| 650 | 4 | |a B cells | |
| 650 | 4 | |a immunosuppression | |
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| 650 | 7 | |a Antibodies, Antineutrophil Cytoplasmic |2 NLM | |
| 700 | 1 | |a Salviani, Chiara |e verfasserin |4 aut | |
| 700 | 1 | |a Tonoli, Mattia |e verfasserin |4 aut | |
| 700 | 1 | |a Affatato, Stefania |e verfasserin |4 aut | |
| 700 | 1 | |a Moratto, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Tedesco, Martina |e verfasserin |4 aut | |
| 700 | 1 | |a Guerini, Alice |e verfasserin |4 aut | |
| 700 | 1 | |a Gemmo, Alessia |e verfasserin |4 aut | |
| 700 | 1 | |a Camoni, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Delbarba, Elisa |e verfasserin |4 aut | |
| 700 | 1 | |a Zubani, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Garrafa, Emirena |e verfasserin |4 aut | |
| 700 | 1 | |a Chiarini, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Gregorini, Gina |e verfasserin |4 aut | |
| 700 | 1 | |a Scolari, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Alberici, Federico |e verfasserin |4 aut | |
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