Abstract: SA-PO663
The Use of Rituximab in ANCA-Negative Pauci-Immune Small Vessel Vasculitis: A Comparative Analysis
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Morris, Adam, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
- Elsayed, Mohamed, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
- Floyd, Lauren, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
- Brady, Mark, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
- Ponnusamy, Arvind, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
- Dhaygude, Ajay Prabhakar, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
Background
Rituximab has been established as an effective treatment strategy for induction-remission of ANCA associated vasculitis, although little is known about its use in the absence of detectable circulating ANCA with respect to its accepted mechanism of action. Due the rare nature of the disease and even smaller subcategory of patients with ANCA negative disease, trials in this area are likely to be challenging. This study aims to determine the treatment outcomes of rituximab as induction therapy in ANCA negative disease.
Methods
A cohort of patients treated with rituximab for induction-remission of pauci-immune small vessel vasculitis was constructed from a single centre between 2006-2018 and followed up until May 2019. Multivariate Cox regression was used to compare treatment outcomes of rituximab between patients with or without detectable circulating ANCA. Primary study outcomes were patient survival, renal survival and disease remission.
Results
58 patients with active disease who required treatment with rituximab were identified. Mean age was 59+14 with a male predominance of 53%. 29% (n=17) had ANCA negative disease at the time of treatment. The overall remission rate irrespective of ANCA serology was 91% (n=53), with a relapse rate of 23% (n=12). On comparative multivariate analysis, ANCA negative disease was not associated with a lower likelihood of remission [HR 0.6 (95% CI 0.19 - 1.85)]. There was no significant difference in subsequent relapse rates between ANCA positive and ANCA negative patients; 21% vs. 27%, respectively (p=0.67). Moreover, the risk of death [HR 2.65 (95% CI 0.32 – 21.76)] and ESRD [HR 0.25 (95% CI 0.03 – 2.04)] were similar between the two groups. Adverse events did not differ between the two groups (p=0.96).
Conclusion
Our centre experience suggests that the use of rituximab is an effective treatment for induction-remission of ANCA negative pauci-immune small vessel vasculitis. To our knowledge, this is the largest cohort analysis of rituximab therapy in seronegative disease reported to date.