Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
Clin Rheumatol. 2022 Sep;41(9):2809-2816. doi: 10.1007/s10067-022-06192-1. Epub 2022 May 4.
Rituximab is a first-line therapy in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Among previous studies evaluating its efficacy, the Hispanic/Latino population has been underrepresented. This study aimed to assess the outcomes of AAV patients treated with rituximab in a tertiary care center in Mexico. This is a retrospective cohort study including patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or renal-limited vasculitis (RLV), who received at least one dose of rituximab (induction or maintenance therapy) from January 2014 to October 2020. Demographic, clinical, serological, histopathological, and treatment-related variables were retrieved. Outcomes were the rate of remission at 6 months during induction and the rate of relapses during maintenance. Damage, serious infections, and death were assessed. Differences between patients with and without remission were analyzed. Forty-two patients received rituximab, 34 of them as induction to remission. Twenty-two patients (65%) achieved remission after 6 months. Patients who achieved remission were younger than those who did not (50 vs. 60 years, p = 0.03). During induction, severe infections, most frequently pneumonia, occurred in 9 (26%), and one patient died. Twenty-four patients received rituximab as maintenance; of them, 23 (96%) achieved complete response, and 8 (33%) experienced relapses (median follow-up time 19 months). During maintenance, severe infections (pneumonia) occurred in 5 patients (21%), and 3 of them (13%) died. In this observational cohort study, the outcomes were similar to the ones reported in other populations, whereas severe infections were frequent and associated with mortality. Key Points • In this study, the outcomes of 42 Mexican patients with ANCA-associated vasculitis treated with rituximab were assessed in a real-life setting. • At 6 months, 65% of the patients achieved remission with rituximab, especially those younger than 50 years of age. • During maintenance therapy with rituximab, 96% of the patients achieved complete response, and 33% experienced relapses. • Severe infections, mostly pneumonia, occurred in 26% of patients during induction and 21% of patients during maintenance therapy with rituximab.
利妥昔单抗是抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）患者的一线治疗药物。在以前评估其疗效的研究中，西班牙裔/拉丁裔人群代表性不足。本研究旨在评估在墨西哥一家三级护理中心接受利妥昔单抗治疗的 AAV 患者的结局。这是一项回顾性队列研究，纳入了接受至少一剂利妥昔单抗（诱导或维持治疗）的肉芽肿性多血管炎（GPA）、显微镜下多血管炎（MPA）或肾血管炎（RLV）患者，时间范围为 2014 年 1 月至 2020 年 10 月。收集了人口统计学、临床、血清学、组织病理学和治疗相关变量。结局是诱导期 6 个月时的缓解率和维持期的复发率。评估了损伤、严重感染和死亡情况。分析了缓解组和未缓解组之间的差异。42 例患者接受了利妥昔单抗治疗，其中 34 例为诱导缓解。22 例（65%）患者在 6 个月后达到缓解。缓解组患者比未缓解组患者更年轻（50 岁 vs. 60 岁，p=0.03）。在诱导期，9 例（26%）患者发生严重感染，最常见的是肺炎，1 例患者死亡。24 例患者接受利妥昔单抗维持治疗；其中 23 例（96%）患者完全缓解，8 例（33%）患者复发（中位随访时间 19 个月）。在维持期，5 例（21%）患者发生严重感染（肺炎），其中 3 例（13%）患者死亡。在这项观察性队列研究中，结局与其他人群报道的相似，而严重感染较为常见，并与死亡率相关。要点•在这项研究中，评估了 42 例在真实环境中接受利妥昔单抗治疗的墨西哥 AAV 患者的结局。•在 6 个月时，65%的患者用利妥昔单抗缓解，尤其是年龄小于 50 岁的患者。•接受利妥昔单抗维持治疗的患者中，96%达到完全缓解，33%复发。•在诱导期和利妥昔单抗维持期，26%的患者发生严重感染（主要为肺炎），21%的患者发生严重感染。
