Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
Int J Rheum Dis. 2023 Dec;26(12):2441-2449. doi: 10.1111/1756-185X.14929. Epub 2023 Oct 2.
This study aimed to investigate the clinical outcomes of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) under rituximab induction and reinduction therapy in Taiwan.
We performed a retrospective study in patients with GPA or MPA receiving rituximab therapy from August 2008 to July 2020 in seven medical centers in Taiwan. The clinical characteristics and outcomes of these patients were analyzed.
In total, 53 patients (18 with GPA and 35 with MPA) were included. Kidney involvement (82.9% vs. 22.2%, p < .001) and initial creatinine (3.25 ± 2.37 vs. 1.07 ± 0.82, p < .001) were significantly higher in MPA. Within 24 weeks after the first course of rituximab, there were seven deaths (five due to infection and two due to active disease) in patients with MPA (7/35, 20%) compared to 0 in patients with GPA. Of 33 patients receiving rituximab for kidney involvement, 23 survived and were free from renal replacement therapy at 24 weeks. Their chronic kidney disease (CKD) stages improved in 2 but progressed in 7, while 24 had stable CKD stages. Death or end-stage renal disease (ESRD) was associated with infection and higher initial creatinine. Reinduction therapy for relapse was required in 18 (39.1%) of 46 survivors, which was associated with anti-proteinase 3 (PR3) positive (odds ratio 3.667, p = .049) and younger age with a cutoff of 49.4 (AUC = 0.679, p = .030, sensitivity = 66.67%, specificity = 75%).
Significant mortality occurred after rituximab induction, especially in patients with MPA. In survivors, age younger than 50 and anti-PR3 positive were associated with the risk of relapse requiring reinduction.
本研究旨在探讨台湾利妥昔单抗诱导和再诱导治疗肉芽肿性多血管炎（GPA）和显微镜下多血管炎（MPA）的临床结局。
我们对 2008 年 8 月至 2020 年 7 月在台湾 7 家医疗中心接受利妥昔单抗治疗的 GPA 或 MPA 患者进行了回顾性研究。分析这些患者的临床特征和结局。
共纳入 53 例患者（18 例 GPA，35 例 MPA）。与 MPA 患者（22.2%）相比，MPA 患者肾脏受累（82.9%）和初始肌酐（3.25±2.37 vs. 1.07±0.82，p<.001）明显更高。在利妥昔单抗首次疗程后 24 周内，MPA 患者中有 7 例死亡（5 例死于感染，2 例死于疾病活动）（7/35，20%），而 GPA 患者无死亡。在接受利妥昔单抗治疗肾脏受累的 33 例患者中，23 例在 24 周时存活且无需肾脏替代治疗。他们的慢性肾脏病（CKD）分期在 2 例中改善，在 7 例中进展，而 24 例的 CKD 分期稳定。感染和较高的初始肌酐与死亡或终末期肾病（ESRD）相关。46 例存活患者中有 18 例（39.1%）需要重新诱导治疗复发，这与抗蛋白酶 3（PR3）阳性相关（比值比 3.667，p=0.049），年龄较小（截定点为 49.4，AUC=0.679，p=0.030，灵敏度=66.67%，特异性=75%）。
利妥昔单抗诱导后死亡率较高，尤其是 MPA 患者。在存活患者中，年龄小于 50 岁和抗-PR3 阳性与需要重新诱导的复发风险相关。
