ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

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: FR-PO652

Analysis of Clinical Outcomes in ANCA-Associated Glomerulonephritis Treated With Rituximab: A Single Center Experience in Japan

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Kawashima, Soko, Kyorin Daigaku Igakubu Fuzoku Byoin, Mitaka, Tokyo, Japan
  • Kaname, Shinya, Kyorin Daigaku Igakubu Fuzoku Byoin, Mitaka, Tokyo, Japan
Background

Contrary to many Western countries, MPO-AAV is dominant in Japan. The therapeutic response to rituximab (RTX) might differ. Therefore, we conducted a retrospective analysis of the clinical database of the 80 ANCA associated glomerulonephritis (ANCA-GN)-patients in our hospital.

Methods

All patients met the CHCC classification criteria for MPA and GPA at disease onset. Eighty patients [53(66%) females)] followed for at least six months since 2014 (up to Mar 2022) were analyzed. Remission was defined as BVAS 0. We divided the ANCA-GN patients into the 4 groups [Group 1 (RTX induction+, maintenance+): 18 cases), Group 2 (RTX induction+, maintenance-): 13), Group 3 (immunosuppressant+): 23) and Group 4 (glucocorticoid only): 26)], and their clinical features and renal prognosis were compared.

Results

Of the 80 patients (53 MPO-MPA, 21 MPO-GPA, and 6 PR3-GPA), patients [25 newly diagnosed or 6 relapsing diseases] received a remission induction with RTX therapy. The frequencies of RPGN in ANCA-GN were 69%, 72% in group 1, 85% in group 2, 22% in group 3 and 73% in group 4, respectively. The average ages at onset were 64.5 ± 15.6, 79.5 ± 5.1, 74.5 ± 8.1, 81.7 ± 5.5 years. The mean ages at the initiation of RTX were 65.8±14.8 in group 1, 80±5.2 in group 2, of which 33%, 92% were over 75 years. Maintenance therapy was given more often based on changes in CD19+ counts and/or ANCA titer in 81%, as compared to scheduled administration every 6 months. The BVAS were 14.3 ± 6.2, 17.9 ± 2.8, 12.2± 4.2, 13.8 ± 5.8. Serum creatinine levels (mg/dl) were 1.9 ± 1.1, 2.7 ± 1.5, 1.7 ± 1.8, 3.1 ± 2.7. Group 1 had high survival and renal survival, which was better than group 3. Most of the deaths in group 2 and 4 were within 1 year, and renal death had already occurred at the intervention within 3 months during induction therapy. Infection was the most common cause of death in all groups. In group 1 and 2, there was a tendency for recovery of renal function 1 year after the induction of remission, indeed, the dialysis withdrawal rates were 88%. The remission rates at 6/12 months were 85/77, 73/55, 92/67, 58/58%. The achievement rates of daily PSL dose of 10mg at 6 months/5mg at 12 months were 62/54, 64/45, 25/8, 26/11%.

Conclusion

These results showed that RTX is effective and has an acceptable safety profile in relatively elder AAV-GN patients in daily practice.