Author: Naz N.; Hiremath M.; Banerjee A.; Shah Y.
Abstract: Introduction and Aims: There is limited data on using rituximab (without cyclophosphamide combination) as the primary immunosuppressive agent in ANCA associated vasculitis with serum creatinine > 354 mumol/l. RAVE excluded such patients; in RITUXIVAS patients received at least 2 doses of intravenous cyclophosphamide along with rituximab.We used rituximab as the main immunosuppressive agent (without cyclophosphamide combination) as induction therapy in 32 ANCA associated vasculitis patients including 15 patients with serum creatinine > 354mumol/l. We grouped our patients into a presenting creatinine of higher or less than 500mumol/l. Our aim was to investigate the renal outcome in these two groups in the first year of presentation and to identify rates of infection, relapse, malignancy and mortality between these groups. Methods:We retrospectively assessed new ANCA associated vasculitis with acute renal failure. Patients were grouped into two based on their presenting serum creatinine. Group A with serum creatinine < 500mumol/l and Group B with serum creatinine >500mumol/l. Serum creatinine at 3, 6 and 12 months of presentation was compared with baseline serum creatinine. Incidence of infection, mortality, malignancy and relapse rate was also compared in these 2 groups at their first 12 months of treatment. Results: All patients received IV methyl prednisolone followed by oral prednisolone with rituximab 375 mg m
weekly for 4 weeks. 11 (7 with serum creatinine >500 mumol/ l) also received plasma exchange. Table 1 show a significant improvement in serum creatinine in both groups at 3, 6 and 12 months of presentation. Serum creatinine plateaued at 3 months in Group A but took more than 3 months in Group B suggesting severe ischemia and acute tubular necrosis in group.We also found no statistically significance difference in infection, relapse, mortality and malignancy rate in the 2 groups at their first year of rituximab therapy. Conclusions:We concluded that rituximab was a very effective and well tolerated induction agent without cyclophosphamide combination in ANCA associated vasculitis irrespective of the level of renal failure.
