期刊
SCANDINAVIAN JOURNAL OF IMMUNOLOGY
卷 76, 期 4, 页码 411-420出版社
WILEY-BLACKWELL
DOI: 10.1111/j.1365-3083.2012.02747.x
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资金
- Gothenburg Medical Society
- Swedish Medical Society
- Swedish Association against Rheumatism
- Gothenburg Association against Rheumatism
- King Gustaf V foundation
- Swedish Medical Research Council
- Nanna Svartz Foundation
- Rune and Ulla Amlovs Foundation
- St. Family Tholens and Kristlers Donations Foundation
- University of Gothenburg
The aim of the study was to evaluate long-term clinical and immunological effects of anti-B cell treatment in patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis refractory to conventional immunosuppressive treatment. Rituximab (RTX) was added to the ongoing immunosuppressive treatment in 29 patients with refractory ANCA-associated vasculitis. The disease activity was measured using Birmingham Vasculitis Activity Score/Wegeners granulomatosis (BVAS/WG score), and clinical laboratory variables were recorded. The median BVAS/WG score before treatment was 6 (IQR 38), and 28 patients (97%) had disease flare classified either severe (62%) or limited (34%). Six of 29 patients (21%) achieved a complete remission, and 12 (41%) had a treatment response with =50% decrease in BVAS/WG score at 6 months. Fourteen patients (64%) with kidney involvement achieved remission, and in seven patients (50%), no flare was seen during the follow-up period. Three patients had renal flare and were successfully re-treated with RTX. Seventeen patients had disease symptoms from airways and eyes at RTX initiation, whereas only 29% displayed =50% treatment response. Limited clinical improvement was seen in patients with endobronchial lesions and trachea-subglottic granulomatous disease. RTX is a potent therapeutic option for ANCA-associated vasculitis refractory to conventional treatment. Best response may be expected in patients with vasculitic manifestations.
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