TY - JOUR
T1 - Brief Report
T2 - Rituximab for the Treatment of Adult-Onset IgA Vasculitis (Henoch-Schönlein)
AU - Maritati, Federica
AU - Fenoglio, Roberta
AU - Pillebout, Evangeline
AU - Emmi, Giacomo
AU - Urban, Maria L.
AU - Rocco, Rossana
AU - Nicastro, Maria
AU - Incerti, Monia
AU - Goldoni, Matteo
AU - Trivioli, Giorgio
AU - Silvestri, Elena
AU - Mohammad, Aladdin J.
AU - Jayne, David
AU - Eriksson, Per
AU - Segelmark, Mårten
AU - Novikov, Pavel
AU - Harris, Helen
AU - Roccatello, Dario
AU - Vaglio, Augusto
N1 - Publisher Copyright:
© 2017, American College of Rheumatology
PY - 2018/1
Y1 - 2018/1
N2 - Objective: Adult-onset IgA vasculitis (Henoch-Schönlein) (IgAV) is a rare systemic vasculitis characterized by IgA1-dominant deposits. The treatment of adult-onset IgAV is controversial and is based on the combination of glucocorticoids and immunosuppressive agents, but many patients have refractory or relapsing disease despite treatment. Rituximab (RTX) is a B cell–depleting antibody of proven efficacy in antineutrophil cytoplasmic antibody–associated vasculitis. We undertook this study to test the efficacy and safety of RTX in a multicenter cohort of patients with adult-onset IgAV. Methods: In this multicenter observational study, we included patients with adult-onset IgAV who had received RTX either for refractory/relapsing disease or because they had contraindications to conventional glucocorticoid/immunosuppressive therapy. We analyzed the rates of remission (defined on the basis of the Birmingham Vasculitis Activity Score [BVAS]) and relapse as well as the variations over time in estimated glomerular filtration rate (GFR), proteinuria, C-reactive protein (CRP) level, BVAS, and prednisone dose. Results: Twenty-two patients were included; their median duration of follow-up was 24 months (interquartile range 18–48 months). Sixteen patients received RTX as add-on therapy and 6 as monotherapy. Twenty patients (90.9%) achieved remission, and 7 of those 20 patients (35%) had subsequent relapse of disease. There were significant reductions in 24-hour proteinuria (P < 0.0001), CRP level (P = 0.0005), BVAS (P < 0.0001), and prednisone dose (P < 0.0001) from RTX initiation through the last follow-up visit; estimated GFR remained stable. RTX was generally well tolerated. One patient died after 60 months of follow-up. Conclusion: Our data suggest that RTX is an effective and safe therapeutic option for adult-onset IgAV.
AB - Objective: Adult-onset IgA vasculitis (Henoch-Schönlein) (IgAV) is a rare systemic vasculitis characterized by IgA1-dominant deposits. The treatment of adult-onset IgAV is controversial and is based on the combination of glucocorticoids and immunosuppressive agents, but many patients have refractory or relapsing disease despite treatment. Rituximab (RTX) is a B cell–depleting antibody of proven efficacy in antineutrophil cytoplasmic antibody–associated vasculitis. We undertook this study to test the efficacy and safety of RTX in a multicenter cohort of patients with adult-onset IgAV. Methods: In this multicenter observational study, we included patients with adult-onset IgAV who had received RTX either for refractory/relapsing disease or because they had contraindications to conventional glucocorticoid/immunosuppressive therapy. We analyzed the rates of remission (defined on the basis of the Birmingham Vasculitis Activity Score [BVAS]) and relapse as well as the variations over time in estimated glomerular filtration rate (GFR), proteinuria, C-reactive protein (CRP) level, BVAS, and prednisone dose. Results: Twenty-two patients were included; their median duration of follow-up was 24 months (interquartile range 18–48 months). Sixteen patients received RTX as add-on therapy and 6 as monotherapy. Twenty patients (90.9%) achieved remission, and 7 of those 20 patients (35%) had subsequent relapse of disease. There were significant reductions in 24-hour proteinuria (P < 0.0001), CRP level (P = 0.0005), BVAS (P < 0.0001), and prednisone dose (P < 0.0001) from RTX initiation through the last follow-up visit; estimated GFR remained stable. RTX was generally well tolerated. One patient died after 60 months of follow-up. Conclusion: Our data suggest that RTX is an effective and safe therapeutic option for adult-onset IgAV.
UR - https://www.scopus.com/pages/publications/85036584277
U2 - 10.1002/art.40339
DO - 10.1002/art.40339
M3 - Article
C2 - 28973844
AN - SCOPUS:85036584277
SN - 2326-5191
VL - 70
SP - 109
EP - 114
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
IS - 1
ER -