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Rituximab versus cyclophosphamide for ANCA-associated vasculitis with renal involvement.

Publication ,  Journal Article
Geetha, D; Specks, U; Stone, JH; Merkel, PA; Seo, P; Spiera, R; Langford, CA; Hoffman, GS; Kallenberg, CGM; St Clair, EW; Fessler, BJ; Ding, L ...
Published in: J Am Soc Nephrol
April 2015

Rituximab (RTX) is non-inferior to cyclophosphamide (CYC) followed by azathioprine (AZA) for remission-induction in severe ANCA-associated vasculitis (AAV), but renal outcomes are unknown. This is a post hoc analysis of patients enrolled in the Rituximab for ANCA-Associated Vasculitis (RAVE) Trial who had renal involvement (biopsy proven pauci-immune GN, red blood cell casts in the urine, and/or a rise in serum creatinine concentration attributed to vasculitis). Remission-induction regimens were RTX at 375 mg/m(2) × 4 or CYC at 2 mg/kg/d. CYC was replaced by AZA (2 mg/kg/d) after 3-6 months. Both groups received glucocorticoids. Complete remission (CR) was defined as Birmingham Vasculitis Activity Score/Wegener's Granulomatosis (BVAS/WG)=0 off prednisone. Fifty-two percent (102 of 197) of the patients had renal involvement at entry. Of these patients, 51 were randomized to RTX, and 51 to CYC/AZA. Mean eGFR was lower in the RTX group (41 versus 50 ml/min per 1.73 m(2); P=0.05); 61% and 75% of patients treated with RTX and 63% and 76% of patients treated with CYC/AZA achieved CR by 6 and 18 months, respectively. No differences in remission rates or increases in eGFR at 18 months were evident when analysis was stratified by ANCA type, AAV diagnosis (granulomatosis with polyangiitis versus microscopic polyangiitis), or new diagnosis (versus relapsing disease) at entry. There were no differences between treatment groups in relapses at 6, 12, or 18 months. No differences in adverse events were observed. In conclusion, patients with AAV and renal involvement respond similarly to remission induction with RTX plus glucocorticoids or CYC plus glucocorticoids.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

April 2015

Volume

26

Issue

4

Start / End Page

976 / 985

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Failure
  • Rituximab
  • Remission Induction
  • Recurrence
  • Middle Aged
  • Male
  • Kidney Function Tests
  • Immunologic Factors
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Geetha, D., Specks, U., Stone, J. H., Merkel, P. A., Seo, P., Spiera, R., … Rituximab for ANCA-Associated Vasculitis Immune Tolerance Network Research Group, . (2015). Rituximab versus cyclophosphamide for ANCA-associated vasculitis with renal involvement. J Am Soc Nephrol, 26(4), 976–985. https://doi.org/10.1681/ASN.2014010046
Geetha, Duvuru, Ulrich Specks, John H. Stone, Peter A. Merkel, Philip Seo, Robert Spiera, Carol A. Langford, et al. “Rituximab versus cyclophosphamide for ANCA-associated vasculitis with renal involvement.J Am Soc Nephrol 26, no. 4 (April 2015): 976–85. https://doi.org/10.1681/ASN.2014010046.
Geetha D, Specks U, Stone JH, Merkel PA, Seo P, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis with renal involvement. J Am Soc Nephrol. 2015 Apr;26(4):976–85.
Geetha, Duvuru, et al. “Rituximab versus cyclophosphamide for ANCA-associated vasculitis with renal involvement.J Am Soc Nephrol, vol. 26, no. 4, Apr. 2015, pp. 976–85. Pubmed, doi:10.1681/ASN.2014010046.
Geetha D, Specks U, Stone JH, Merkel PA, Seo P, Spiera R, Langford CA, Hoffman GS, Kallenberg CGM, St Clair EW, Fessler BJ, Ding L, Tchao NK, Ikle D, Jepson B, Brunetta P, Fervenza FC, Rituximab for ANCA-Associated Vasculitis Immune Tolerance Network Research Group. Rituximab versus cyclophosphamide for ANCA-associated vasculitis with renal involvement. J Am Soc Nephrol. 2015 Apr;26(4):976–985.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

April 2015

Volume

26

Issue

4

Start / End Page

976 / 985

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Failure
  • Rituximab
  • Remission Induction
  • Recurrence
  • Middle Aged
  • Male
  • Kidney Function Tests
  • Immunologic Factors
  • Humans