ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO407

The Cyclophosphamide-Sparing Role of an Intensified B-Cells Depletion Protocol in ANCA-Associated Vasculitis: A Case-Control Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Fenoglio, Roberta, Hospital Hub San Giovanni, Turin, Italy, Italy
  • Sciascia, Savino, Center of Research of Immunopathology and Rare Diseases (CMID), Division of Clinical Immunology, Giovanni Bosco Hospital and University of Turin, Ita, Turin, Italy, Italy
  • Roccatello, Dario, Ospedale San GIovanni Bosco, Torino, Italy
Background

ANCA-associated vasculitis (AAV) are systemic diseases with relapsing chronic course. The management of AAV requires the use of immunosuppressive drugs whose use is associated with potential toxicity. This case-control study aims to evaluate the immunosuppressive-sparing effect of rituximab (RTX) used with cyclophosphamide (CYC), compared to a traditional regimen based on high-dose CYC.

Methods

26 patients (pts) with AAV with a necrotising extracapillary glomerulonephritis were prospectively enrolled. 13 pts received the intensified protocol of B-lymphocyte depletion therapy (IBCDT) “4+2” with RTX and CYC (4 weekly infusions of RTX followed by 2 monthly followed by prednisone tapered to 5 mg/day in 3 months). 13 pts treated with the high-dose CYC treatment protocol followed by azathioprine as maintenance therapy were enrolled as controls.

Results

In the 13 cases treated with the IBCDT we observed a significant reduction in mean values of parameter of disease activity. After administration of RTX, a significant reduction of the mean s-creatinine values and BVAS was observed. All pts had full B-cell depletion on peripheral blood after the first IBCDT protocol after 1 year. No further maintenance therapy was given. In the cases, a response was observed in 8/13 cases. 4 pts did not respond and a death was observed for cardiovascular causes. No significant difference was observed in terms of response to therapy between the two groups. The IBCDT allows a significant reduction in the cumulative dose of CYC to which each patient was exposed during follow-up, reaching statistical significance levels (p <0.001). Calculated on a monthly basis, the "4+2" protocol allowed an average reduction in the CYC cumulative dose equivalent to 827 mg/month.

Conclusion

in a selected sample of patients with AAV with renal involvement, the IBCT regimen appeared to be non inferior in terms of the efficacy when compared to CYC-based standard regimens. Moreover, the IBCDT regimen allowed a net reduction in the cumulative average dose of CYC to which pts are exposed, quantifiable in approximately 1g/month.