Evaluation of PR3-ANCA Status After Rituximab for ANCA-Associated Vasculitis.
Evaluation of PR3-ANCA Status After Rituximab for ANCA-Associated Vasculitis.
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DOI：
10.1097/rhu.0000000000001030
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发表时间：
2019-08
期刊：
影响因子：
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通讯作者：
Jones RB
中科院分区：
文献类型：
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作者：
McClure ME;Wason J;Gopaluni S;Tieu J;Smith RM;Jayne DR;Jones RB
抗中性粒细胞细胞质抗体（ANCA）在确诊为ANCA相关血管炎（AAV）的患者中评估疾病活动性或预测复发的价值仍存在争议，但最近的证据表明，美罗华单抗治疗的患者可能发挥作用。所有在2011年1月至2016年1月期间在阿登布鲁克医院开始为期2年的利妥昔单抗诱导缓解治疗的活动性血管炎和蛋白酶3 (PR3) -ANCA阳性患者纳入本研究。常见的科室做法是：2年内给予6克利妥昔单抗，同时使用皮质类固醇（0.5-1.0 mg/kg）， 3个月内快速减量，并在首次服用利妥昔单抗时停止口服维持免疫抑制剂。使用电子病历回顾性收集临床和实验室资料。57例PR3-ANCA阳性患者纳入分析。中位随访时间为59个月。PR3-ANCA阴性25例（44%），中位时间为14个月。53例患者（93%）达到临床缓解，中位时间为3个月。在随访期间获得缓解的53例患者中，24例（45%）复发，从缓解到复发的中位时间为36个月。PR3-ANCA阴性状态和PR3-ANCA较基线降低50%（作为时变协变量）与较长的复发时间显著相关（PR3-ANCA阴性状态：风险比为0.08[95%置信区间，0.01-0.63,p = 0.016]； PR3-ANCA降低50%：风险比为0.25[95%置信区间，0.18-0.99,p = 0.046]）。利妥昔单抗后实现并维持PR3-ANCA阴性与更持久的缓解相关。
The value of antineutrophil cytoplasmic antibody (ANCA) measurements among patients with an established diagnosis of ANCA-associated vasculitis (AAV) to assess disease activity or predict relapse remains controversial, but recent evidence suggests a possible role for rituximab-treated patients. All patients with active vasculitis and positive proteinase 3 (PR3)–ANCA who were starting a 2-year treatment course of rituximab for induction of remission at Addenbrooke’s Hospital between January 2011 and January 2016 were included in this study. Common department practice consists of 6 g of rituximab given over 2 years, concomitant corticosteroids (0.5–1.0 mg/kg) with rapid taper over 3 months, and cessation of oral maintenance immunosuppressive agents at time of first rituximab dose. Clinical and laboratory data were collected retrospectively using electronic patient records. Fifty-seven patients with current PR3-ANCA positivity were included in the analysis. Median follow-up was 59 months. PR3-ANCA negativity was achieved in 25 patients (44%) with a median time of 14 months. Clinical remission was achieved in 53 patients (93%) with a median time of 3 months. Among the 53 patients who achieved remission during follow-up, 24 (45%) relapsed with a median time to relapse of 36 months from remission. Both PR3-ANCA–negative status and 50% reduction in PR3-ANCA from baseline (as time-varying covariates) were significantly associated with a longer time to relapse (PR3-ANCA–negative status: hazards ratio, 0.08 [95% confidence interval, 0.01–0.63, p = 0.016]; 50% reduction in PR3-ANCA: hazards ratio, 0.25 [95% confidence interval, 0.18–0.99, p = 0.046]). Achieving and maintaining PR3-ANCA negativity after rituximab was associated with longer-lasting remission.