TY - JOUR
T1 - Rituximab Therapy for Systemic Rheumatoid Vasculitis
T2 - Indications, Outcomes, and Adverse Events
AU - Coffey, Caitrin M.
AU - Richter, Michael D.
AU - Crowson, Cynthia S.
AU - Koster, Matthew J.
AU - Warrington, Kenneth J.
AU - Ytterberg, Steven R.
AU - Makol, Ashima
N1 - Publisher Copyright:
© 2020 Journal of Rheumatology. All rights reserved.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Objective. To characterize the indication, outcomes, and adverse effects of rituximab (RTX) treatment in a large single-center cohort of patients with systemic rheumatoid vasculitis (RV). Methods. We retrospectively reviewed the medical charts of 17 patients treated with RTX for systemic RV from 2000 to 2017. Clinical characteristics, outcomes, and adverse effects were analyzed. Results. At RV diagnosis, mean age was 59 years, 59% were female, 94% were white, and 82% had positive rheumatoid factor. At the time of initiating RTX, median Birmingham Vasculitis Activity Score for rheumatoid arthritis was 4.0 (interquartile range 2.0-7.5). RV presented in the skin in 8 patients (47%), as mononeuritis multiplex in 2 (12%), inflammatory ocular disease in 2 (12%), and affected multiple organ systems in 5 (29%). RTX was used for induction therapy in 8 patients (47%), relapsing RV in 4 (24%), second-line therapy in 2 (12%), and salvage therapy or in combination with another agent in 3 (18%). At 3 months, 2 (13%) of 15 patients with available followup information achieved complete remission (CR), and 10 (67%) achieved partial response (PR). At 6 months, 6 patients (40%) achieved CR, 8 (53%) achieved PR, and one had no response. At 12 months, 8 of 13 patients with available records (62%) had CR and 5 patients (38%) had PR. Conclusion. Systemic RV is difficult to treat effectively. CR of RV was achieved in 62% and PR in 38% of patients within 12 months of RTX use. Further evidence is needed to inform treatment for patients with RV. (First Release November 15 2019; J Rheumatol 2020;47:518-23; doi:10.3899/jrheum.181397).
AB - Objective. To characterize the indication, outcomes, and adverse effects of rituximab (RTX) treatment in a large single-center cohort of patients with systemic rheumatoid vasculitis (RV). Methods. We retrospectively reviewed the medical charts of 17 patients treated with RTX for systemic RV from 2000 to 2017. Clinical characteristics, outcomes, and adverse effects were analyzed. Results. At RV diagnosis, mean age was 59 years, 59% were female, 94% were white, and 82% had positive rheumatoid factor. At the time of initiating RTX, median Birmingham Vasculitis Activity Score for rheumatoid arthritis was 4.0 (interquartile range 2.0-7.5). RV presented in the skin in 8 patients (47%), as mononeuritis multiplex in 2 (12%), inflammatory ocular disease in 2 (12%), and affected multiple organ systems in 5 (29%). RTX was used for induction therapy in 8 patients (47%), relapsing RV in 4 (24%), second-line therapy in 2 (12%), and salvage therapy or in combination with another agent in 3 (18%). At 3 months, 2 (13%) of 15 patients with available followup information achieved complete remission (CR), and 10 (67%) achieved partial response (PR). At 6 months, 6 patients (40%) achieved CR, 8 (53%) achieved PR, and one had no response. At 12 months, 8 of 13 patients with available records (62%) had CR and 5 patients (38%) had PR. Conclusion. Systemic RV is difficult to treat effectively. CR of RV was achieved in 62% and PR in 38% of patients within 12 months of RTX use. Further evidence is needed to inform treatment for patients with RV. (First Release November 15 2019; J Rheumatol 2020;47:518-23; doi:10.3899/jrheum.181397).
KW - Biological therapy
KW - Rheumatoid arthritis
KW - Vasculitis
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U2 - 10.3899/jrheum.181397
DO - 10.3899/jrheum.181397
M3 - Article
C2 - 31203225
AN - SCOPUS:85082978950
SN - 0315-162X
VL - 47
SP - 518
EP - 523
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 4
ER -