Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
Division of Rheumatology, Department of Internal Medicine, Seirei Yokohama Hospital, 215 Iwai Hodogaya, Yokohama, Kanagawa, 240-8521, Japan.
Clin Rheumatol. 2019 Apr;38(4):1217-1223. doi: 10.1007/s10067-019-04443-2. Epub 2019 Jan 25.
Administration of four once-weekly doses of 375 mg/m rituximab (RTX) is commonly used as remission induction therapy for ANCA-associated vasculitis (AAV). Low-dose RTX has been recently shown to produce closely similar results to conventional treatments in other autoimmune diseases. However, the therapeutic potential of this approach in AAV remains largely unknown. Here, we analyzed the efficacy and tolerability of high- and low-dose regimens of RTX in patients with AAV. We retrospectively examined AAV patients who met the classification algorithm of Watts et al. from 2006 to 2016. Patients were divided into high- (HD) and low-dose (LD) RTX groups. HD-RTX was the original regimen while LD-RTX consisted of two once-weekly doses of 375 mg/m. Cumulative complete remission (CR) rates for 1 year were compared, and serial changes in peripheral B cell counts and serious adverse events were monitored. Apart from a higher percentage of elderly patients in the LD group (p < 0.01), the 17 patients with HD-RTX and 11 patients with LD-RTX showed no significant differences in clinical characteristics, including Birmingham Vasculitis Activity Score (BVAS), Vasculitis Damage Index (VDI), and the initial dose of glucocorticoid. On 1-year observation, cumulative CR rates did not significantly differ (p = 0.20). Further, peripheral B cell counts and incidence of serious adverse events also did not differ. Cumulative CR rate did not significantly differ between LD and HD groups. Further study is warranted to confirm these results.
每周一次给予 375mg/m 的利妥昔单抗（RTX）四次是常用的抗中性粒细胞胞浆抗体相关性血管炎（AAV）缓解诱导治疗。最近有研究表明，低剂量 RTX 在其他自身免疫性疾病中的治疗效果与常规治疗非常相似。然而，这种方法在 AAV 中的治疗潜力在很大程度上仍不清楚。在此，我们分析了高剂量和低剂量 RTX 方案在 AAV 患者中的疗效和耐受性。我们回顾性地检查了 2006 年至 2016 年符合瓦茨等人分类算法的 AAV 患者。患者分为高剂量（HD）和低剂量（LD）RTX 组。HD-RTX 为原始方案，LD-RTX 由每周两次给予 375mg/m 的剂量组成。比较了 1 年的累积完全缓解（CR）率，并监测了外周 B 细胞计数和严重不良事件的变化。除了 LD 组老年患者比例较高（p<0.01）外，17 例接受 HD-RTX 和 11 例接受 LD-RTX 的患者在临床特征方面（包括伯明翰血管炎活动评分（BVAS）、血管炎损伤指数（VDI）和初始剂量的糖皮质激素）无显著差异。在 1 年的观察中，累积 CR 率无显著差异（p=0.20）。此外，外周 B 细胞计数和严重不良事件的发生率也没有差异。LD 和 HD 组之间的累积 CR 率无显著差异。需要进一步的研究来证实这些结果。
