Rituximab for ANCA-associated vasculitides.
Among new treatments for ANCA-associated vasculitis, rituximab is the most promising. It has already been demonstrated that rituximab is not inferior to cyclophosphamide in inducing remission. This drug is therefore an alternative to cyclophosphamide for induction treatment. In the long term, it has been shown that patients who have received 4 infusions of rituximab to induce remission, not followed by a maintenance treatment, have the same relapse rate as patients who have been treated with azathioprine for maintenance. This high relapse rate supports a maintenance treatment which could also be rituximab. The results obtained with rituximab vs. azathioprine are encouraging and could favour rituximab use, but long-term results are still needed. Rituximab is safe and side effect frequency and severity are comparable to the side effects observed in patients treated with cyclophosphamide for induction, and azathioprine or methotrexate for maintenance. New studies are needed to evaluate the long-term side effects of this biotherapy.
Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Autoimmunes Rares, Université Paris-Descartes, AP-HP, Hôpital Cochin, Paris, France. loic.guillevin@orange.fr.
Loic
L
Guillevin
D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy* / Q000276:immunology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D003520:Cyclophosphamide / Q000627:therapeutic use; D016903:Drug Monitoring; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D054539:Medication Therapy Management; D012074:Remission Induction / Q000379:methods; D000069283:Rituximab; D055502:Secondary Prevention; D016896:Treatment Outcome
D019268:Antibodies, Antineutrophil Cytoplasmic; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide