Rituximab induction and reinduction in granulomatosis with polyangiitis and microscopic polyangiitis: A retrospective multicenter study in Taiwan

Author:

Hsieh Tsu‐Yi12,Chen Ming‐Han34,Wu Chen‐Ching5,Hong Wei‐Jhe6,Lu Cheng‐Hsun7ORCID,Lu Chun‐Chi8ORCID,Lu Ling‐Ying9,Hsieh Song‐Chou7,Tsai Chang‐Youh1011,Wu Chien‐Sheng1112ORCID,

Affiliation:

1. Division of Allergy, Immunology, and Rheumatology Taichung Veterans General Hospital Taichung Taiwan

2. Department of Medical Education Taichung Veterans General Hospital Taichung Taiwan

3. Division of Allergy, Immunology, and Rheumatology Taipei Veterans General Hospital Taipei Taiwan

4. Faculty of Medicine National Yang Ming Chiao Tung University Taipei Taiwan

5. Department of Internal Medicine Kaohsiung Medical University Chung‐Ho Memorial Hospital Kaohsiung Taiwan

6. Division of Rheumatology and Immunology, Department of Internal Medicine China Medical University Hospital Taichung Taiwan

7. Division of Rheumatology, Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan

8. Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine Tri‐Service General Hospital Taipei Taiwan

9. Division of Allergy, Immunology, and Rheumatology, Department of Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan

10. Division of Immunology and Rheumatology Fu Jen Catholic University Hospital New Taipei City Taiwan

11. School of Medicine Fu Jen Catholic University New Taipei City Taiwan

12. Division of Allergy, Immunology, and Rheumatology Far Eastern Memorial Hospital New Taipei City Taiwan

Abstract

AbstractObjectivesThis study aimed to investigate the clinical outcomes of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) under rituximab induction and reinduction therapy in Taiwan.MethodsWe performed a retrospective study in patients with GPA or MPA receiving rituximab therapy from August 2008 to July 2020 in seven medical centers in Taiwan. The clinical characteristics and outcomes of these patients were analyzed.ResultsIn total, 53 patients (18 with GPA and 35 with MPA) were included. Kidney involvement (82.9% vs. 22.2%, p < .001) and initial creatinine (3.25 ± 2.37 vs. 1.07 ± 0.82, p < .001) were significantly higher in MPA. Within 24 weeks after the first course of rituximab, there were seven deaths (five due to infection and two due to active disease) in patients with MPA (7/35, 20%) compared to 0 in patients with GPA. Of 33 patients receiving rituximab for kidney involvement, 23 survived and were free from renal replacement therapy at 24 weeks. Their chronic kidney disease (CKD) stages improved in 2 but progressed in 7, while 24 had stable CKD stages. Death or end‐stage renal disease (ESRD) was associated with infection and higher initial creatinine. Reinduction therapy for relapse was required in 18 (39.1%) of 46 survivors, which was associated with anti‐proteinase 3 (PR3) positive (odds ratio 3.667, p = .049) and younger age with a cutoff of 49.4 (AUC = 0.679, p = .030, sensitivity = 66.67%, specificity = 75%).ConclusionSignificant mortality occurred after rituximab induction, especially in patients with MPA. In survivors, age younger than 50 and anti‐PR3 positive were associated with the risk of relapse requiring reinduction.

Publisher

Wiley

Subject

Rheumatology

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