Abstract: SA-PO260

Combination Therapy with Rituximab and Cyclophosphamide for Remission Induction in ANCA Vasculitis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Cortazar, Frank B., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Muhsin, Saif A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Pendergraft, William Franklin, University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
  • Wallace, Zachary S, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Dunbar, Colleen B, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Laliberte, Karen A., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Niles, John, Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Remission induction in ANCA vasculitis may be complicated by slow response to treatment and toxicity from glucocorticoids. More effective and less toxic regimens are needed.

Methods

Patients were included if they had ANCA vasculitis and were treated with a standardized remission induction regimen (SIR): Rituximab 1000 mg Q 2 weeks x 2 doses, oral cyclophosphamide 2.5 mg/kg x 1 week and 1.5 mg/Kg x 7 weeks (adjusted for eGFR), and a rapid prednisone taper that lowers the dose to ≤ 15mg/d by 1 month. Complete remission (CR) was defined as a BVAS-WG of 0 and a prednisone dose ≤ 7.5 mg/d.

Results

We identified 129 patients treated with the SIR, 31% of whom also received PLEX for RPGN or pulmonary hemorrhage (PH). Seventy percent of patients had MPO-ANCA and 30% had PR3-ANCA. Median time to CR was 4 months (IQR, 3.9 to 4.4), and by 5 months 84% of patients were in CR. Prednisone was tapered to discontinuation as tolerated, such that the median prednisone dose at 8 months was 0 mg/day (IQR, 0 to 2.5). In patients with RPGN (n=75), PR3-ANCA was associated with a greater increase in eGFR at 6 months compared with MPO-ANCA (16.1 [IQR 0.0 to 22.5] versus 5.6 [IQR, -0.4 to 15.6] ml/min/1.73m2; p=0.028). During the first year following CR, 1 major relapse occurred over 122 patient-years. Serious infections occurred more frequently in patients receiving PLEX and were associated with increasing age and PH. Four deaths occurred, 3 of which were associated with serious infections.

Conclusion

Combination therapy with rituximab and cyclophosphamide was efficacious, allowed for rapid tapering of high-dose glucocorticoids and was well tolerated.

Funding

  • NIDDK Support