Use of rituximab in severe ANCA-associated vasculitis


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Abstract

Purpose. Evaluation of effectiveness of rituximab in patients with severe vasculitis, associated with antineutrophil cytoplasmic antibodies (ANCA).
Material and methods. Retrospective study included 11 patients with ANCA-associated vasculitis (9 - with Wegener's granulomatosis, 1 - with microscopic polyangiitis and Churg-Strauss syndrome), treated with rituximab. ANCA were typing in all patients, and physical examination was performed in relation to specific organ damage.
Results. As a result of treatment, complete remission was achieved in 7 (63.6%) patients, partial remission - in 4 (36.4%). The dose of prednisolone was reduced from 38.2 to 10.0 (at 6 months) and 7.5 mg/day (at 12 months). Treatment with nonselective cytotoxic drugs was discontinued in 10 (90.9%) patients. Recurrences developed in 4 (36.4%) patients, in 2 patients at 6 months after the administration of rituximab - fatal, and in 2 patients - at 15 and 45 months (in both cases refresh course of rituximab allowed to re-achieve complete remission). Tolerability of treatment was satisfactory.
Conclusion. Rituximab has demonstrated efficacy in regard to steroid dependence at the later stages of disease (in case of ineffectiveness of better-studied cytotoxic drugs). It seems, in some situations, rituximab may also be used for induction of remission of vasculitis in the early stages of the disease

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