Rituximab Therapy for Systemic Rheumatoid Vasculitis: Indications, Outcomes, and Adverse Events.

Abstract

OBJECTIVE:

To characterize the indication, outcomes, and adverse effects of rituximab (RTX) treatment in a large single-center cohort of patients with systemic rheumatoid vasculitis (RV).

METHODS:

We retrospectively reviewed the medical charts of 17 patients treated with RTX for systemic RV from 2000 to 2017. Clinical characteristics, outcomes, and adverse effects were analyzed.

RESULTS:

At RV diagnosis, mean age was 59 years, 59% were female, 94% were white, and 82% had positive rheumatoid factor. At the time of initiating RTX, median Birmingham Vasculitis Activity Score for rheumatoid arthritis was 4.0 (interquartile range 2.0-7.5). RV presented in the skin in 8 patients (47%), as mononeuritis multiplex in 2 (12%), inflammatory ocular disease in 2 (12%), and affected multiple organ systems in 5 (29%). RTX was used for induction therapy in 8 patients (47%), relapsing RV in 4 (24%), second-line therapy in 2 (12%), and salvage therapy or in combination with another agent in 3 (18%). At 3 months, 2 (13%) of 15 patients with available followup information achieved complete remission (CR), and 10 (67%) achieved partial response (PR). At 6 months, 6 patients (40%) achieved CR, 8 (53%) achieved PR, and one had no response. At 12 months, 8 of 13 patients with available records (62%) had CR and 5 patients (38%) had PR.

CONCLUSION:

Systemic RV is difficult to treat effectively. CR of RV was achieved in 62% and PR in 38% of patients within 12 months of RTX use. Further evidence is needed to inform treatment for patients with RV.

• Authors: Caitrin M Coffey, Michael D Richter, Cynthia S Crowson, Matthew J Koster, Kenneth J Warrington, Steven R Ytterberg, Ashima Makol
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 47 Issue 4 Pg. 518-523 (04 2020) ISSN: 0315-162X [Print] Canada
• PMID: 31203225 (Publication Type: Journal Article)

Chemical References

• Rituximab

Topics

• Arthritis, Rheumatoid (drug therapy)
• Female
• Humans
• Middle Aged
• Retrospective Studies
• Rheumatoid Vasculitis (drug therapy)
• Rituximab (adverse effects)
• Treatment Outcome