title: Long-term effects of rituximab added to cyclophosphamide in refractory patients with vasculitis.
abstract: BACKGROUND
  Current therapies have changed systemic vasculitis from a disease with a high rate of mortality to a chronic curable condition. A limited percentage of patients either remains refractory to conventional treatment or experiences dose-limiting side effects.
  
  
  METHODS
  11 patients (4 affected by idiopathic systemic microscopic polyangiitis, 5 by Wegener's granulomatosis, and 2 by Churg-Strauss syndrome) intolerant or refractory to conventional therapies including cyclophosphamide were enrolled. All patients received rituximab as a rescue therapy and were followed for 30-54 months. Following rituximab administration, immunosuppressive drugs were rapidly tapered and no immunosuppressive maintenance therapy was given.
  
  
  RESULTS
  Significant decreases in levels of serum creatinine, proteinuria, erythrocyte sedimentation rate, C-reactive protein, and ANCA titers were observed during the follow-up (at least 30 months after rituximab administration). Arthralgia and weakness rapidly disappeared in all patients. Out of 7 patients, 5 reported a decrease in the degree of paresthesia and in the electrophysiologic parameters. Six months after rituximab administration the mean dose of prednisone was 5.5 mg/day.
  
  
  CONCLUSIONS
  In this sample of patients with systemic vasculitis who were refractory or intolerant to more conventional treatment, rituximab proved to be safe and effective in a long-term follow-up, and showed steroid- and immunosuppressive-sparing effects allowing the persistence of long-lasting remissions without maintenance therapy.
authors.affiliation: Dipartimento di Malattie Rare, Immunologiche, Ematologiche ed Immunoematologiche, Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare (CMID), Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale Torino Nord Emergenza San G. Bosco ed Università di Torino, Italia. dario.roccatello @ unito.it
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.forename: Daniela
authors.initials: D
authors.lastname: Rossi
authors.forename: Mirella
authors.initials: M
authors.lastname: Alpa
authors.forename: Carla
authors.initials: C
authors.lastname: Naretto
authors.forename: Alessandra
authors.initials: A
authors.lastname: Russo
authors.forename: Elisa
authors.initials: E
authors.lastname: Menegatti
authors.forename: Simone
authors.initials: S
authors.lastname: Baldovino
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods*; D004594:Electrophysiology / Q000379:methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D016896:Treatment Outcome; D014657:Vasculitis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide