Yashiro-Furuya Makiko, Sato Shuzo, Akanuma Momo, Sato Kairi, Suzuki Eiji, Kanno Takashi, Matsumoto Haruki, Temmoku Jumpei, Fujita Yuya, Matsuoka Naoki, Asano Tomoyuki, Kobayashi Hiroko, Watanabe Hiroshi, Migita Kiyoshi
Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Rheumatology, Ohta-Nishinouchi Hospital, Fukushima, Japan.
Mod Rheumatol. 2023 Mar 2;33(2):352-359. doi: 10.1093/mr/roac027.
Rituximab (RTX) efficacy for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has been reported in large randomized studies; however, the efficacy of RTX in Japanese AAV patients, especially the elderly, is not well known. We aimed to determine the clinical efficacy of RTX in Japanese AAV patients including elderly patients.
This study included 78 AAV patients newly diagnosed with AAV and treated in Fukushima Medical University Hospital or Ohta-Nishinouchi Hospital from April 2004 to September 2019. Clinical records were retrospectively reviewed, and clinical efficacy and outcome (1-year survival) between the RTX treatment group (23 cases) and the conventional therapy group (immunosuppressive therapy other than RTX, 55 cases) were compared. We also analysed the clinical efficacy and outcome in elderly-onset (>75 years) AAV patients.
The RTX group showed similar efficacy and 1-year survival compared to the conventional therapy group. Conversely, after 6 months of treatment, prednisolone doses significantly decreased in the RTX group compared to the conventional therapy group (p < 0.01). In the elderly-onset AAV patients, clinical efficacy and outcome were not significantly different.
RTX was effective in Japanese AAV patients and may be useful for prompt tapering of prednisolone doses, even in elderly-onset AAV patients.
大型随机研究已报道利妥昔单抗（RTX）治疗抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）的疗效；然而，RTX在日本AAV患者尤其是老年患者中的疗效尚不清楚。我们旨在确定RTX在包括老年患者在内的日本AAV患者中的临床疗效。
本研究纳入了2004年4月至2019年9月期间在福岛医科大学医院或太田西之内医院新诊断为AAV并接受治疗的78例患者。对临床记录进行回顾性分析，比较RTX治疗组（23例）和传统治疗组（除RTX外的免疫抑制治疗，55例）的临床疗效和结局（1年生存率）。我们还分析了老年发病（>75岁）AAV患者的临床疗效和结局。
与传统治疗组相比，RTX组显示出相似的疗效和1年生存率。相反，治疗6个月后，RTX组的泼尼松龙剂量与传统治疗组相比显著降低（p<0.01）。在老年发病的AAV患者中，临床疗效和结局无显著差异。
RTX对日本AAV患者有效，甚至对老年发病的AAV患者，可能有助于迅速减少泼尼松龙剂量。
