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Rituximab may be effective for systemic rheumatoid vasculitis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with systemic vasculitis associated with rheumatoid arthritis respond well to rituximab therapy, French investigators report in Arthritis Care & Research online November 10.

“Complete remission of SRV was achieved in nearly three quarters of patients receiving rituximab treatment in daily practice, with a significant decrease in prednisone dosage and an acceptable toxicity profile,” Dr. Xavier Puechal, with Le Mans General Hospital, and colleagues conclude.

They explain that a small subset of patients with long-standing seropositive rheumatoid arthritis may be affected with systemic vasculitis. Rituximab has been shown to induce remission in severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and might be similarly helpful in systemic rheumatoid vasculitis (SRV).

To investigate, the team examined data in the nationwide Autoimmunity and Rituximab registry. They identified 1994 patients with rheumatoid arthritis who were treated with rituximab. In this group, 17 had confirmed, active SRV.

After 6 months of rituximab treatment, 12 of the patients had complete remission of vasculitis, 4 had a partial response, and 1 had died, the investigators found.

At baseline, the mean score in the SRV group on a standard vasculitis activity scale was 9.6 and the mean prednisone dosage was 19.2 mg/day; those values were reduced to 0.6 and 9.7 mg/day, respectively, after 6 months of rituximab, according to the report.

Regarding safety, there were three cases of severe infection; one patient died of sepsis, one developed subcutaneous abscess with cellulitis, and the third had a relapse of post-surgical infection in an elbow prosthesis.

None of six patients who received subsequent rituximab treatments on a preemptive basis experienced a relapse. However, among those receiving either methotrexate alone or no maintenance therapy, three had a relapse of vasculitis. Remission was restored in two of the latter cases with further rituximab treatments, Dr. Puechal and colleagues report.

Based on these findings, they conclude, “Rituximab represents a suitable therapeutic option to induce remission in SRV but maintenance therapy seems to be necessary.”

At last follow-up, the authors report, 16 patients were still alive and 15 were in sustained complete remission.

Reference:

Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis. Results from the autoimmunity and rituximab registry

Arthritis Care Res 2011.