Rituximab for remission induction in elderly patients with ANCA-associated vasculitis.
Rituximab for remission induction in elderly patients with ANCA-associated vasculitis.
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DOI：
10.1016/j.semarthrit.2015.02.005
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发表时间：
2015-08
影响因子：
5
通讯作者：
Geetha D
中科院分区：
文献类型：
--
作者：
Timlin H;Lee SM;Manno RL;Seo P;Geetha D
对于接受环磷酰胺 (CYC) 和糖皮质激素 (GC) 诱导缓解的 AAV 患者来说，年龄增长是治疗相关副作用和死亡的危险因素。利妥昔单抗 (RTX) 在老年 AAV 患者中的疗效和安全性尚未得到很好的描述。我们对 31 名连续使用 RTX 诱导缓解的 60 岁或以上 AAV 患者进行了单中心回顾性评价。所有患者均接受 RTX 联合 GC 诱导缓解。 4 名患者同时接受 CYC 治疗，平均持续时间为 52 天。我们评估了诊断时的临床和实验室变量、定义为伯明翰血管炎活动评分/韦格纳肉芽肿病 (BVAS/WG) = 0 的完全缓解率以及患者生存率、肾脏生存率、需要住院治疗的感染以及使用 RTX 后 24 个月的血管炎复发率。 31 名患者中，77% 为白人，68% 为女性，平均年龄为 71 ± 6 岁，58% 为 MPO ANCA 阳性，42% 患有复发性疾病。平均 BVAS/WG 评分为 4.4 ± 1.5，71% 患有肾小球肾炎 (GN)，10% 患有肺泡出血。平均基线 e-GFR 为 40 ± 28 ml/min/1.73 m2。 30 名患者获得缓解，平均缓解时间为 57 ± 27 天。唯一一位患有难治性血管炎的患者对 CYC 有反应。 6 个月时的平均泼尼松剂量为 5.6 ± 4 mg。 6 名患者（4 名使用 RTX，1 名使用硫唑嘌呤，1 名使用吗替麦考酚酯）在 RTX 诱导后 12 个月内开始缓解维持治疗。一名患者在使用 RTX 后 10 个月出现有限复发。在 22 名基线时患有 GN 的患者中，1 名发展为 ESRD。经过至少 1 年随访的 25 名患者的一年生存率为 100%。没有发生输注反应或白细胞减少症。细菌性肺炎3例，念珠菌肺炎1例，播散性皮肤带状疱疹1例。这项研究表明，利妥昔单抗对于老年 AAV 患者的诱导缓解有效。此外，我们观察到感染并发症的发生率很高。我们的经验因其回顾性设计而受到限制，需要进一步研究来评估 RTX 对老年 AAV 患者的疗效和安全性。
Advancing age is a risk factor for treatment-related side effects and mortality in AAV patients treated with cyclophosphamide (CYC) and glucocorticoids (GC) for remission induction. The efficacy and safety of rituximab (RTX) in elderly AAV patients has not been well described. We performed a single center retrospective review of 31 consecutive AAV patients aged 60 or more at the time of RTX use for remission induction. All patients received RTX with GC for remission induction. Four patients received concomitant CYC for a mean duration of 52 days. We evaluated clinical and laboratory variables at diagnosis, rates of complete remission defined as Birmingham Vasculitis Activity Score/Wegener's Granulomatosis (BVAS/WG) = 0 and patient survival, renal survival, infections requiring hospitalization, and vasculitis relapse 24 months following RTX use. Of the 31 patients, 77% were Caucasian, 68% female, mean age was 71 ± 6 years, 58% were MPO ANCA positive, and 42% had relapsing disease. The mean BVAS/WG score entry was 4.4 ± 1.5, 71% had glomerulonephritis (GN) and 10% had alveolar hemorrhage. The mean baseline e-GFR was 40 ± 28 ml/ min/1.73 m2. Thirty patients achieved remission with a mean time to remission of 57 ± 27 days. The single patient with refractory vasculitis responded to CYC. The mean prednisone dose at 6 months was 5.6 ± 4 mg. Remission maintenance therapy was started within 12 months of RTX induction in 6 patients (4 with RTX, 1 with azathioprine, and 1 with mycophenolate mofetil). One patient suffered a limited relapse 10 months post RTX use. Among the 22 patients with GN at baseline, 1 developed ESRD. One-year patient survival among 25 patients with at least 1 year of follow-up was 100%. There were no episodes of infusion reaction or leukopenia. There were 3 episodes of bacterial pneumonia, 1 episode of candida pneumonia, and 1 episode of disseminated cutaneous zoster. This study demonstrates that rituximab is effective for remission induction in elderly patients with AAV. Furthermore, we observed a high incidence of infectious complications. Our experience was limited by its retrospective design, and further studies are needed to evaluate the efficacy and safety of RTX in elderly AAV patients.