Abstract: PUB164
Efficacy and Safety of Induction Treatment with Rituximab, Mycophenolate, and Low Doses of Corticoids in Patients with ANCA-Associated Vasculitis
Session Information
Category: Glomerular Diseases
- 1202 Glomerular Diseases: Immunology and Inflammation
Authors
- Garcia Villa, Jose Luis, Son Espases University Hospital, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, ES,, Palma de Mallorca, Illes Balears, Spain
- Uriol Rivera, Miguel, Son Espases University Hospital, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, ES,, Palma de Mallorca, Illes Balears, Spain
- Obrador, Aina, Son Espases University Hospital, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, ES,, Palma de Mallorca, Illes Balears, Spain
- Egea, Cristina, Son Espases University Hospital, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, ES,, Palma de Mallorca, Illes Balears, Spain
- Villagrasa, Tania, Son Espases University Hospital, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, ES,, Palma de Mallorca, Illes Balears, Spain
Background
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (VAA) increases considerably the risk of requiring chronic renal support therapy (CRST) and death. Induction treatment with cyclophosphamide and corticosteroids is not always effective and has adverse effects. The kidney biopsy (KB) is usually required prior to the start of treatment; however, the clinical presentation and the systemic nature may influence the time of its performance. We report the efficacy and safety of pre-KB initiation of induction therapy using Rituximab, low-dose steroids, and mycophenolate.
We report the adverse effects during follow-up. Induction protocol methylprednisolone 250mg (x3), Rituximab 1gr (x2), mycophenolate 500mg / 12h. Maintenance therapy consisted in mycophenolate and prednisone.
Methods
Nineteen consecutive patients were included. Follow-up period: means (min-max): 28 (3-64) months. Average age 65 years. Patients treated pre-KB 17 (90%). It was also administered during induction: immunoglubulins in 10 (53%) patients and plasmapheresis in 8 (42%). 2 patients (11%) required Eculizumab as rescue therapy. 15 (79%) patients were anti-MPO + [title: median: 281 (84-570) AU / ml]. Berden's classification selected the following patterns: sclerotic: 5 (26%), focal: 5 (26%), crescentic 2 (11%), 3 (16%) insufficient material, mixed: 1 (5%) and 3 ( 16%) patients were not biopsied.
Results
The current survival it was 100% and only 2 (11%) require CRST (one of them had a baseline GFR of 9ml / min / 1.73m2). The median (p25-p75) of eGFR at the momento of presentation was 17.9 (7.8–27.2) ml / min / 1.73m2. The average eGFR increased globally during follow-up in 9.9ml / min / 1.73m2 (P <0.01, eta2partial: 0.46); those with sclerotic histology 7.3ml / min / m2 (P = 0.26) and in those without available histology 10ml / min / 1.73m2 (P = 0.04, eta2parcial: 0.21). The regimen was tolerated satisfactoroly, we registred 5 patients with infections issues (26%) [2 (11%) required hospital admission]. No patient developed steroid-induced DM.
Conclusion
The early use of this induction regimen was associated with excellent overall and renal survival. The safety profile and systemic nature of VAAs seems to justify the early use of immunosuppression even in those treated without available histology.