title: Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: Results from the AutoImmunity and Rituximab Registry.
abstract: OBJECTIVE
  Rituximab improves articular symptoms in rheumatoid arthritis (RA) and it recently has been shown to be an effective induction therapy for antineutrophil cytoplasmic antibody-associated vasculitis. We assessed the efficacy and safety of rituximab in a real-life clinical setting among patients with systemic rheumatoid vasculitis (SRV).
  
  
  METHODS
  We analyzed data from the AutoImmunity and Rituximab registry, which includes patients with autoimmune diseases treated with rituximab.
  
  
  RESULTS
  Of the 1,994 patients with RA enrolled in the registry, 17 were treated with rituximab for active SRV. At baseline, the mean Birmingham Vasculitis Activity Score for RA (BVAS/RA) was 9.6, with a mean prednisone dosage of 19.2 mg/day. After 6 months of rituximab therapy, 12 patients (71%) achieved complete remission of their vasculitis, 4 had a partial response, and 1 died with uncontrolled vasculitis. Mean BVAS/RA was reduced to 0.6 and mean prednisone dosage to 9.7 mg/day. At 12 months, 14 patients (82%) were in sustained complete remission. Severe infection occurred in 3 patients, corresponding to a 6.4 per 100 patient-years rate. In the 6 patients who received further rituximab as maintenance therapy between months 6 and 12, no relapse of vasculitis was observed. However, among the 9 patients who did not, a relapse was observed in 3 patients who were treated with methotrexate alone. Remission was reestablished by reintroducing rituximab in 2 cases.
  
  
  CONCLUSIONS
  Complete remission of SRV was achieved in nearly three-fourths of patients receiving rituximab in daily practice, with a significant decrease in daily prednisone dosage and an acceptable toxicity profile. Rituximab represents a suitable therapeutic option to induce remission in SRV, but maintenance therapy seems to be necessary.
authors.affiliation: Le Mans General Hospital, Le Mans, and Cochin Hospital, Paris, France. xpuechal@ch-lemans.fr
authors.forename: X
authors.initials: X
authors.lastname: Puéchal
authors.forename: J E
authors.initials: JE
authors.lastname: Gottenberg
authors.forename: J M
authors.initials: JM
authors.lastname: Berthelot
authors.forename: L
authors.initials: L
authors.lastname: Gossec
authors.forename: O
authors.initials: O
authors.lastname: Meyer
authors.forename: J
authors.initials: J
authors.lastname: Morel
authors.forename: D
authors.initials: D
authors.lastname: Wendling
authors.forename: M
authors.initials: M
authors.lastname: de Bandt
authors.forename: E
authors.initials: E
authors.lastname: Houvenagel
authors.forename: B
authors.initials: B
authors.lastname: Jamard
authors.forename: T
authors.initials: T
authors.lastname: Lequerré
authors.forename: G
authors.initials: G
authors.lastname: Morel
authors.forename: P
authors.initials: P
authors.lastname: Richette
authors.forename: J
authors.initials: J
authors.lastname: Sellam
authors.forename: L
authors.initials: L
authors.lastname: Guillevin
authors.forename: X
authors.initials: X
authors.lastname: Mariette
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D000069283:Rituximab; D056647:Systemic Vasculitis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab