From the Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge University Hospitals.
MRC Biostatistics Unit, University of Cambridge, Cambridge.
J Clin Rheumatol. 2019 Aug;25(5):217-223. doi: 10.1097/RHU.0000000000001030.
The value of antineutrophil cytoplasmic antibody (ANCA) measurements among patients with an established diagnosis of ANCA-associated vasculitis (AAV) to assess disease activity or predict relapse remains controversial, but recent evidence suggests a possible role for rituximab-treated patients.
All patients with active vasculitis and positive proteinase 3 (PR3)-ANCA who were starting a 2-year treatment course of rituximab for induction of remission at Addenbrooke's Hospital between January 2011 and January 2016 were included in this study. Common department practice consists of 6 g of rituximab given over 2 years, concomitant corticosteroids (0.5-1.0 mg/kg) with rapid taper over 3 months, and cessation of oral maintenance immunosuppressive agents at time of first rituximab dose. Clinical and laboratory data were collected retrospectively using electronic patient records.
Fifty-seven patients with current PR3-ANCA positivity were included in the analysis. Median follow-up was 59 months. PR3-ANCA negativity was achieved in 25 patients (44%) with a median time of 14 months. Clinical remission was achieved in 53 patients (93%) with a median time of 3 months. Among the 53 patients who achieved remission during follow-up, 24 (45%) relapsed with a median time to relapse of 36 months from remission. Both PR3-ANCA-negative status and 50% reduction in PR3-ANCA from baseline (as time-varying covariates) were significantly associated with a longer time to relapse (PR3-ANCA-negative status: hazards ratio, 0.08 [95% confidence interval, 0.01-0.63, p = 0.016]; 50% reduction in PR3-ANCA: hazards ratio, 0.25 [95% confidence interval, 0.18-0.99, p = 0.046]).
Achieving and maintaining PR3-ANCA negativity after rituximab was associated with longer-lasting remission.
在已确诊为抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）的患者中，评估疾病活动度或预测复发时，抗中性粒细胞胞浆抗体（ANCA）测量的价值仍存在争议，但最近的证据表明利妥昔单抗治疗的患者可能具有一定作用。
本研究纳入了 2011 年 1 月至 2016 年 1 月期间在阿登布鲁克医院开始为期 2 年利妥昔单抗诱导缓解治疗的活动性血管炎和阳性蛋白酶 3（PR3）-ANCA 的患者。常规科室实践包括在 2 年内给予 6 g 利妥昔单抗，同时给予皮质类固醇（0.5-1.0 mg/kg），在 3 个月内快速减量，并在首次给予利妥昔单抗时停止口服维持性免疫抑制剂。临床和实验室数据通过电子病历回顾性收集。
共纳入 57 例目前 PR3-ANCA 阳性的患者进行分析。中位随访时间为 59 个月。25 例（44%）患者达到 PR3-ANCA 阴性，中位时间为 14 个月。53 例（93%）患者达到临床缓解，中位时间为 3 个月。在随访期间达到缓解的 53 例患者中，24 例（45%）复发，从缓解到复发的中位时间为 36 个月。PR3-ANCA 阴性状态和 PR3-ANCA 基线降低 50%（作为时变协变量）均与复发时间延长显著相关（PR3-ANCA 阴性状态：风险比，0.08[95%置信区间，0.01-0.63，p=0.016]；PR3-ANCA 降低 50%：风险比，0.25[95%置信区间，0.18-0.99，p=0.046]）。
利妥昔单抗治疗后达到并维持 PR3-ANCA 阴性与更长时间的缓解相关。
