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: PO1728

Low- vs. Standard-Dose Rituximab for Induction and Maintenance Treatment of ANCA-Associated Vasculitis in Elderly Patients: A Single-Centre Observational Study

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Rehman, Shams Ur, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, United Kingdom
  • Metraiah, Elhakem, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, United Kingdom
  • Kidder, Dana, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, United Kingdom
Background

ANCA associated vasculitis (AAV) affects more than 20 per million population per year, with a peak age of 65-74 years. Elderly patients (Age > 65 years) with AAV tend to have higher rates of mortality and treatment-related adverse events. However, outcomes are better for those treated with immunosuppressive regimens. Rituximab is now widely used in the treatment of AAV based on the results of randomized controlled trials. Elderly patients were relatively under-represented in these trials. We aimed to examine the outcome of elderly patients who received either low dose Rituximab (LDR) or standard-dose (SDR) for remission induction and maintenance.

Methods

We investigated the outcome of three treatment strategies in the elderly patients who presented with AAV to our Vasculitis clinic from July 1, 2007 to July 9, 2017. These strategies included: LDR (17 patients), SDR (14 patients) and Cyclophosphamide/Azathioprine (Cyc/A) 26 patients. LDR patients received two doses of 500mg Rituximab fortnightly followed by six monthly 500mg doses for 2 years. SDR patients received 1g Rituximab fortnightly followed by six monthly 1g doses for 2 years. Cyc/A patients received 1.5mg/kg oral Cyclophosphamide for 3 months followed by 18 months of Azathioprine.

Results

Among 57 AAV patients, 17 received LDR, 14 received SDR and 26 were treated with Cyc/A. 56% were females, mean age of 79.6 +/- 4 (LDR), 72.4 +/- 7.2 (SDR), and 71.1 +/- 5 (Cyc/A) (p=0.001). The distribution of MPA and GPA was 11:6 in LDR, 7:7 in SDR and 18:8 in Cyc/A, respectively. Relapsing AAV was significantly higher in SDR 12 of 14 compared to LDR 3 of 17, and Cyc/A none (p=0.0001). There were no significant differences in serum creatinine, BVAS scores or CRP between groups. Patients survival at 24 months was 88% (LDR), 92% (SDR), and 77% (Cyc), p=0.3. The mean corticosteroids dose at 3 months from onset of treatment was significantly lower in the LDR (7.6 +/- 1.7) and SDR (8.6 +/- 3.1) compared with Cyc/A (12.5 +/- 3.6), p=0.001. One patient relapsed in the SDR group and 4 in the Cyc/A group. Hospitalization for infections were significantly lower in the LDR (3 episodes) compared to Cyc/A (17 episodes), p=0.004.

Conclusion

Low dose Rituximab for remission induction and maintenance was associated with similar patient outcome compared to SDR.