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Abstract: PO1729

Efficacy of Rituximab and Plasma Exchange in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with Severe Renal Disease

Session Information

Category: Glomerular Diseases

  • 1202 Glomerular Diseases: Immunology and Inflammation

Authors

  • Casal Moura, Marta Isabel Rodrigues, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Irazabal, Maria V., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Eirin, Alfonso, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Sethi, Sanjeev, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Berti, Alvise, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Baqir, Misbah, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Winters, Jeffrey L., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Cartin-ceba, Rodrigo, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Thompson, Gwen, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Makol, Ashima, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Warrington, Kenneth, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Borah, Bijan J., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Thao, Viengneesee, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Specks, Ulrich, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Background

Treatment of patients with ANCA-associated vasculitis (AAV) and severe renal involvement is not established. We describe outcomes in response to rituximab (RTX) versus cyclophosphamide (CYC) and plasma exchange (PLEX).

Methods

A retrospective cohort study on MPO- or PR3-ANCA positive patients with AAV (MPA and GPA) and severe renal disease (eGFR<30mL/min/1.73m2). Remission, relapse, end-stage renal disease (ESRD) and death after remission-induction with CYC or RTX, with or without the use of PLEX were compared.

Results

Of 467 patients with active renal involvement, 251 had severe renal disease. Patients received CYC (n=161) or RTX (n=64) for remission-induction, and 51 were also treated with PLEX. Predictors for ESRD and/or death at 18 months were eGFR<15mL/min/1.73m2 at diagnosis (HR 3.092, [95%CI 1.493-6.401], p=0.002), renal recovery (HR 0.274, [95%CI 0.118-0.637],p=0.003) and renal remission at 6 months (HR 0.402, [95%CI 0.179-0.902],p=0.027). RTX was comparable to CYC in remission-induction (BVAS/WG=0) at 6 months (HR 1.374, [95%CI 0.909-2.076];p=0.132). Addition of PLEX showed no benefit on remission-induction at 6 months (HR 0.732, [95%CI 0.440-1.219],p=0.230), in the rate of ESRD and/or death at 18 months (HR 1.052,[95%CI 0.508-2.180], p=0.891), in progression to ESRD (HR 1.056, [95%CI 0.496–2.247], p=0.887), or survival at 24 months (HR 0.542, [95%CI 0.159–1.853], p=0.330).

Conclusion

The apparent benefits and risks of using CYC or RTX for the treatment of patients with AAV and severe renal disease are balanced. The addition of PLEX to standard remission-induction therapy showed no benefit in our cohort.