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Abstract: SA-PO408

B Cell Suppression and Relapse of Vasculitis in Maintenance Therapy of Rituximab for Granulomatosis with Polyangiitis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Karube, Miho, Kyorin University School of Medicine, Tokyo, Japan
  • Kawashima, Soko, Kyorin University School of Medicine, Tokyo, Japan
  • Kaname, Shinya, Kyorin University School of Medicine, Tokyo, Japan
Background

The protocol of rituximab (RTX) use during the maintenance treatment for ANCA-associated vasculitis has not been established. Thus, we retrospectively investigated the efficacy of RTX between the regular and “on-demand” use in patients with granulomatosis with polyangiitis (GPA).

Methods

The subjects were 8 GPA patients in our hospital, and RTX was introduced by refractory active vasculitis with cyclophosphamide (CY) treatment difficulties or CY contraindications. The Japanese 8 patients with GPA refractory to or contraindicated for cyclophosphamide (CY) were investigated. The patients were 6 males and 2 females, with the median ages of 68 years old, and we compared B cell counts, relapse rates between 6 regular-use cases with every 6 months and 2 on-demand-use cases when RTX were administered after the reconstitution of B cells. We also examined glucocorticoid doses and safety profiles.

Results

The RTX were used as a single dose of 375 mg/m2 in all patients. The periods from remission to the initial maintenance therapy were 7 to 12 months. The two “on-demand” patients showed eGFR less than 45 ml/min /1.73 m 2. In the regular-use group, no relapses of vasculitis or reappearance of B cells were observed. In the on-demand-use cases, the reappearance of B cells was seen after 8.5 months on average, and one of the two cases showed relapse of vasculitis with worsening renal function, proteinuria and CRP positivity after an interval of 20 months. Both groups showed comparable glucocorticoid doses and no serious infection was observed in both groups.

Conclusion

It is suggested that the regular use of RTX was well tolerated and may show persistent remission induction, rather than on-demand use, in the maintenance treatment for patients with GPA, although further study in the large cohort is required.