Kallenberg Cees G M
Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Curr Opin Rheumatol. 2014 May;26(3):292-8. doi: 10.1097/BOR.0000000000000049.
To discuss in detail the efficacy and safety of rituximab (RTX) for induction and maintenance of remission in patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) who are either treatment naive, relapsing or refractory to standard of care.
In treatment naive AAV patients, RTX without maintenance treatment is as effective as cyclophosphamide (CYC) followed by azathioprine (AZA) for maintenance for up to 18 months. RTX is superior to CYC for induction of remission in patients with relapsing AAV. Nevertheless, long-term follow-up shows relapsing disease in up to 50% of patients with proteinase 3-ANCA, irrespective of the induction regimen. RTX is useful in patients with refractory AAV, but percentages of patients achieving complete remission differ between series. RTX seems more effective than AZA for maintaining remission, but detailed results from prospective studies are being awaited. Adverse events do not differ between RTX and classical induction regimens, but infections related to hypogammaglobulinemia and neutropenia could be items of concern with repeated administration of RTX.
RTX is an alternative for CYC for induction of remission in generalized AAV and could be first choice for relapsing patients and patients refractory to CYC. RTX is promising for maintenance of remission, but long-term safety should be awaited.
详细讨论利妥昔单抗（RTX）在初治、复发或对标准治疗难治的抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者诱导缓解及维持缓解中的疗效和安全性。
在初治AAV患者中，未进行维持治疗的RTX与环磷酰胺（CYC）后序贯硫唑嘌呤（AZA）维持治疗长达18个月的疗效相当。在复发AAV患者中，RTX诱导缓解优于CYC。然而，长期随访显示，高达50%的蛋白酶3-ANCA患者会出现疾病复发，与诱导方案无关。RTX对难治性AAV患者有用，但不同系列中达到完全缓解的患者百分比有所不同。RTX在维持缓解方面似乎比AZA更有效，但前瞻性研究的详细结果仍有待观察。RTX与传统诱导方案的不良事件无差异，但反复使用RTX可能会出现与低丙种球蛋白血症和中性粒细胞减少相关的感染问题。
在全身性AAV诱导缓解方面，RTX可作为CYC的替代方案，对于复发患者及对CYC难治的患者可作为首选。RTX在维持缓解方面前景良好，但长期安全性仍有待观察。
