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Treatment of Severe Renal Disease in ANCA Positive and Negative Small Vessel Vasculitis with Rituximab.
Department of Medicine, Johns Hopkins University, Baltimore, Md., USA..
Department of Nephrology, Charles University, Prague , Czech.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology.
University of Birmingham.
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2015 (English)In: American Journal of Nephrology, ISSN 0250-8095, E-ISSN 1421-9670, Vol. 41, no 4-5, 296-301 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIMS: Rituximab and glucocorticoids are a non-inferior alternative to cyclophosphamide and glucocorticoid therapy for induction of remission in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) patients with moderate renal disease. The efficacy and safety of this approach in patients with severe renal impairment are unknown. We report the outcomes and safety profile of rituximab and glucocorticoid therapy for induction of remission in patients with AAV and ANCA-negative vasculitis presenting with severe renal disease.

METHODS: A multicenter, retrospective, cohort study was conducted between 2005 and 2014. Patients with new or relapsing disease with an estimated glomerular filtration rate (eGFR) of ≤20 ml/min/1.73 m(2) treated with rituximab and glucocorticoid induction with or without plasmapheresis were included. Fourteen patients met the inclusion criteria. The primary outcomes were rate of remission and dialysis independence at 6 months. The secondary outcomes were eGFR at 6 months, end-stage renal disease (ESRD), survival rates and adverse events.

RESULTS: All patients were Caucasian, and 57% were male. The mean eGFR was 12 ml/min/1.73 m(2) at diagnosis. All patients achieved remission with a median time to remission of 55 days. Seven patients required dialysis at presentation of which 5 patients recovered renal function and discontinued dialysis by 6-month follow-up. The mean eGFR for the 11 patients without ESRD who completed 6-month follow-up was 33 ml/min/1.73 m(2). Four patients ultimately developed ESRD, and one died during the follow-up period.

CONCLUSION: Patients with AAV and severe renal disease achieve high rates of remission and dialysis independence when treated with rituximab and glucocorticoids without cyclophosphamide. © 2015 S. Karger AG, Basel.

Place, publisher, year, edition, pages
S. Karger, 2015. Vol. 41, no 4-5, 296-301 p.
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:liu:diva-119921DOI: 10.1159/000431336ISI: 000358515000005PubMedID: 26044574OAI: oai:DiVA.org:liu-119921DiVA: diva2:838483
Note

Funding for this project was provided by the Donald B. and Dorothy L. Stabler Foundation.

Available from: 2015-06-30 Created: 2015-06-30 Last updated: 2015-08-24

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Segelmark, Mårten
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Division of Drug ResearchFaculty of Medicine and Health SciencesDepartment of Nephrology
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