Shah Shivani, Hruskova Zdenka, Segelmark Marten, Morgan Matthew D, Hogan Jonathan, Lee Steven K, Dale Jessica, Harper Lorraine, Tesar Vladimir, Jayne David R W, Geetha Duvuru
Department of Medicine, Johns Hopkins University, Baltimore, Md., USA.
Am J Nephrol. 2015;41(4-5):296-301. doi: 10.1159/000431336. Epub 2015 Jun 2.
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.
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.
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.
Patients with AAV and severe renal disease achieve high rates of remission and dialysis independence when treated with rituximab and glucocorticoids without cyclophosphamide.
背景/目的：对于中度肾病的抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者，利妥昔单抗和糖皮质激素是诱导缓解的环磷酰胺和糖皮质激素疗法的非劣效替代方案。这种方法在严重肾功能损害患者中的疗效和安全性尚不清楚。我们报告了利妥昔单抗和糖皮质激素疗法诱导AAV和伴有严重肾病的ANCA阴性血管炎患者缓解的结果及安全性。
在2005年至2014年期间进行了一项多中心、回顾性队列研究。纳入了估计肾小球滤过率（eGFR）≤20 ml/min/1.73 m²的新发病例或复发疾病患者，接受利妥昔单抗和糖皮质激素诱导治疗，有或无血浆置换。14例患者符合纳入标准。主要结局为6个月时的缓解率和脱离透析率。次要结局为6个月时的eGFR、终末期肾病（ESRD）、生存率和不良事件。
所有患者均为白种人，57%为男性。诊断时平均eGFR为12 ml/min/1.73 m²。所有患者均实现缓解，缓解的中位时间为55天。7例患者在就诊时需要透析，其中5例患者肾功能恢复，在6个月随访时停止透析。完成6个月随访的11例无ESRD患者的平均eGFR为33 ml/min/1.73 m²。4例患者最终发展为ESRD，1例在随访期间死亡。
AAV和严重肾病患者在接受利妥昔单抗和糖皮质激素而非环磷酰胺治疗时，实现缓解和脱离透析的比例较高。
