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Original article
Efficacy and safety of rituximab in the treatment of eosinophilic granulomatosis with polyangiitis
  1. Vítor Teixeira1,2,
  2. Aladdin J Mohammad1,3,
  3. Rachel B Jones1,
  4. Rona Smith1 and
  5. David Jayne1
  1. 1Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
  2. 2Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
  3. 3Clinical Sciences, Rheumatology, Lund University, Lund, Skåne, Sweden
  1. Correspondence to Dr Vítor Teixeira,Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; vitor.as.teixeira{at}gmail.com

Abstract

Introduction Eosinophilic granulomatosis with polyangiitis (EGPA) is a subset of antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis with distinct pathophysiological mechanisms, clinical features and treatment responses. Rituximab is a licensed therapy for granulomatosis with polyangiitis and microscopic polyangiitis but there is limited experience of rituximab in EGPA.

Methods EGPA patients from a tertiary centre who received rituximab for mostly refractory EGPA or in whom cyclophosphamide was contra indicated were studied. A standardised dataset was collected at time of initial treatment and every 3 months for 24 months. Response was defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 and partial response as ≥50% reduction in BVAS from baseline. Remission was defined as a BVAS of 0 on prednisolone dose ≤5 mg.

Results Sixty-nine patients (44 female) received rituximab between 2003 and 2017. Improvement (response and partial response) was observed in 76.8% of patients at 6 months, 82.8% at 12 months and in 93.2% by 24 months, while relapses occurred in 54% by 24 months, with asthma being the most frequent manifestation. The median BVAS decreased from 6 at baseline to 1 at 6 months, and 0 at 12 and 24 months. Prednisolone dose (mg/day, median) decreased from 12.5 to 7, 7.5 and 5 at 6, 12 and 24 months, respectively. ANCA positive patients had a longer asthma/ear, nose and throat (ENT) relapse-free survival time and a shorter time to remission.

Discussion Rituximab demonstrated some efficacy in EGPA and led to a reduction in prednisolone requirement, but asthma and ENT relapse rates were high despite continued treatment. The ANCA positive subset appeared to have a more sustained response on isolated asthma/ENT exacerbations.

  • systemic vasculitis
  • eosinophilic granulomatosis with polyangiitis
  • ANCA
  • rituximab
  • asthma

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Footnotes

  • Contributors All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DJ has received research grants from Roche/Genentech and consulting fees from Astra-Zeneca, Celgene, Chemocentryx, CSL, GSK, Insmed and Sanofi/Genzyme.

  • Patient consent for publication Not required.

  • Ethics approval According to the UK National Health Service Research Ethics Committee guidelines, ethics approval was not required for an anonymised retrospective study; all treatment decisions were made prior to our evaluation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data may be obtained from a third party and are not publicly available.

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