Rituximab as induction therapy in relapsing eosinophilic granulomatosis with polyangiitis: A report of 6 cases.
OBJECTIVE
Recently few reports have suggested a potential benefit of rituximab in patients with eosinophilic granulomatosis with polyangiitis (EGPA). However, the current evidence is limited. We describe the efficacy and safety of rituximab in six patients with relapsing EGPA.


METHODS
Candidates for rituximab therapy were selected from a cohort of 118 patients with EGPA. The main indication for B-cells depletion was moderately severe or severe relapsing disease that was refractory to conventional immunosuppression. A primary end-point was a complete or partial remission within 3 to 6 months after rituximab administration.


RESULTS
All six patients (four ANCA-positive and two ANCA-negative) had active EGPA manifesting by severe lung disease and/or deteriorating peripheral neuropathy. The median duration of follow-up after the first rituximab dose administration was 10 months. All patients rapidly responded to rituximab treatment, e.g. disappearance of lung infiltrates, improvement of asthmatic symptoms, at least partial recovery of motor and sensory function. Within 3 to 6 months, complete (4/6) or partial (2/6) remission was achieved in all patients. After switching to rituximab all patients except one discontinued cyclophosphamide or other immunomodulators. Four patients continued maintenance treatment with rituximab. One patient developed severe bronchospasm during infusion and two patients presented with moderately severe purulent bronchitis that was successfully treated with intravenous antibiotics.


CONCLUSIONS
Our retrospective case series suggest that rituximab may be effective for induction of remission in selected EGPA patients. These data warrant further studies to evaluate safety and efficacy of rituximab in EGPA.
Clinic of Nephrology, Internal and Occupational Diseases, Rossolimo 11/5, Moscow 119435, Russia; Sechenov First Moscow State Medical University, Moscow, Russia.
Pavel
P
Novikov
Clinic of Nephrology, Internal and Occupational Diseases, Rossolimo 11/5, Moscow 119435, Russia; Sechenov First Moscow State Medical University, Moscow, Russia. Electronic address: clinpharm@mtu-net.ru.
Sergey
S
Moiseev
Russian Peoples' Friendship University, Moscow 119435, Russia.
Ilya
I
Smitienko
Clinic of Nephrology, Internal and Occupational Diseases, Rossolimo 11/5, Moscow 119435, Russia; Sechenov First Moscow State Medical University, Moscow, Russia.
Eugenia
E
Zagvozdkina
D000328:Adult; D000368:Aged; D015267:Churg-Strauss Syndrome / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*
D007155:Immunologic Factors; D000069283:Rituximab
Eosinophilic granulomatosis with polyangiitis; Rituximab; Treatment