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10.1002/art.24637

http://scihub22266oqcxt.onion/10.1002/art.24637
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19565480!ä!19565480

suck abstract from ncbi


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pmid19565480      Arthritis+Rheum 2009 ; 60 (7): 2156-68
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  • A multicenter survey of rituximab therapy for refractory antineutrophil cytoplasmic antibody-associated vasculitis #MMPMID19565480
  • Jones RB; Ferraro AJ; Chaudhry AN; Brogan P; Salama AD; Smith KG; Savage CO; Jayne DR
  • Arthritis Rheum 2009[Jul]; 60 (7): 2156-68 PMID19565480show ga
  • OBJECTIVE: B cell depletion with rituximab has allowed remissions in relapsing or refractory antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in small studies. The aim of this study was to determine the efficacy and safety of rituximab for ANCA-associated vasculitis in a larger multicenter cohort. This permitted comparison of rituximab dosing regimens, the value of continuing immunosuppression, and investigation of ANCA and B cell levels as re-treatment biomarkers. METHODS: Retrospective, standardized data collection from 65 sequential patients receiving rituximab for refractory ANCA-associated vasculitis at 4 centers in the UK was used. RESULTS: All patients achieved B cell depletion. Complete remission occurred in 49 of the 65 patients (75%), partial remission in 15 (23%), and no response in 1 (2%). The prednisolone dosage was reduced from 12.5 mg/day (median) to 9.0 mg/day at 6 months (P = 0.0006). Immunosuppressive therapy was withdrawn in 37 of 60 patients (62%). Twenty-eight of 49 patients who achieved full remission (57%) experienced relapse (median 11.5 months). B cell return preceded relapse in 14 of 27 patients (52%). Although ANCA levels fell after rituximab therapy, relapse was not associated with ANCA positivity or a rise in ANCA levels. Neither the initial rituximab regimen (4 infusions of 375 mg/m(2) each given 1 week apart or 2 infusions of 1 gm each given 2 weeks apart) nor withdrawal of immunosuppressive therapy (37 of 60 patients [62%]) influenced the timing of relapse. Thirty-eight patients received >or=2 courses of rituximab, and complete remission was induced or maintained in 32 of them (84%). IgM levels fell, although IgG levels remained stable. Forty-six serious adverse events occurred, including 2 episodes of late-onset neutropenia, which were attributed to rituximab. CONCLUSION: Rituximab was effective remission induction therapy for refractory ANCA-associated vasculitis in this study. There was no difference in efficacy between the 2 main treatment regimens. Continuing immunosuppression did not reduce relapses. Relapses occurred, but re-treatment was effective and safe. There was no clear influence of rituximab on the frequency of serious adverse events. ANCA and B cell levels lacked sufficient sensitivity to guide the timing of re-treatment.
  • |Adolescent[MESH]
  • |Adult[MESH]
  • |Aged[MESH]
  • |Antibodies, Antineutrophil Cytoplasmic/*metabolism[MESH]
  • |Antibodies, Monoclonal, Murine-Derived[MESH]
  • |Antibodies, Monoclonal/adverse effects/pharmacology/*therapeutic use[MESH]
  • |Antirheumatic Agents/adverse effects/pharmacology/*therapeutic use[MESH]
  • |B-Lymphocytes/drug effects/metabolism/pathology[MESH]
  • |Biomarkers/metabolism[MESH]
  • |Child[MESH]
  • |Cohort Studies[MESH]
  • |Dose-Response Relationship, Drug[MESH]
  • |Female[MESH]
  • |Follow-Up Studies[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Remission Induction[MESH]
  • |Retrospective Studies[MESH]
  • |Rituximab[MESH]
  • |Secondary Prevention[MESH]
  • |Treatment Outcome[MESH]
  • |Vasculitis/*drug therapy/*immunology[MESH]


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