Repeat cycles of rituximab on clinical relapse in ANCA-associated vasculitis: identifying B cell biomarkers for relapse to guide retreatment decisions.
Ann Rheum Dis
; 74(9): 1734-8, 2015 Sep.
Article
em En
| MEDLINE
| ID: mdl-25854586
ABSTRACT
OBJECTIVE:
To assess clinical and B cell biomarkers to predict relapse after rituximab in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) using retreatment on clinical relapse strategy.METHODS:
35 patients with AAV received treatment with 2×1000â mg rituximab, repeated on clinical relapse (up to 5â cycles). Disease activity was assessed by Birmingham Vasculitis Activity Score (BVAS) and peripheral B cell subsets using highly sensitive flow cytometry (HSFC) as previously described; both performed at baseline and every 3â months.RESULTS:
Response rates were high >83%, with median time-to-relapse of 82â weeks for cycle 1 (C1) and >54â weeks for all cycles. Prior to rituximab, AAV was characterised by naïve B-lymphopenia compared to healthy controls. This dysregulation was more marked in patients with raised C-reactive protein (CRP) (p<0.05). In C1, no clinical feature predicted relapse. However, repopulation of naïve B cell at 6â months was associated with a reduced risk of relapse (HR 0.326, 95% 0.114 to 0.930, p=0.036). Relapse rates at 12 and 18â months were 0% and 14% with naïve repopulation at 6â months, and 31% and 54% without naïve repopulation.CONCLUSIONS:
Responses to B cell depletion therapy are long-lasting and relapse post-treatment may be predicted by absence of naïve B cell repopulation at 6â months. Naïve B-lymphopenia may be a biomarker of disease activity in AAV.Palavras-chave
Texto completo:
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Antirreumáticos
/
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos
/
Anticorpos Monoclonais Murinos
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Rheum Dis
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Reino Unido