Abstract: SA-PO765
Rituximab in Addition to Plasma Exchange, Cyclophosphamide, and Steroids for the Treatment of Anti-glomerular Basement Membrane (GBM) Disease
Session Information
- ANCA-Associated Vasculitis, Anti-GBM Disease, and Other RPGN
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Srikantharajah, Mukunthan, Imperial College London, London, United Kingdom
- Chappell, Jacob, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
- Prendecki, Maria, Imperial College London, London, United Kingdom
- Makanjuola, David, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
- Sood, Bhrigu Raj, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, Sutton, United Kingdom
- McAdoo, Stephen Paul, Imperial College London, London, United Kingdom
Background
Anti-GBM disease is a rare antibody-mediated vasculitis, usually treated with plasma exchange (PEX), cyclophosphamide (CYC) and steroids. There are limited data regarding the use of B-cell depleting therapies such as rituximab (RTX).
Methods
Two-centre retrospective cohort study of patients presenting from 2003-2023 with anti-GBM disease treated with or without RTX, in addition to standard care, as first-line therapy.
Results
Seventy-eight patients are included; baseline demographics, disease characteristics, treatments and outcomes are summarised in Table 1. All patients were treated with PEX, CYC (oral or IV), and steroids. The addition of RTX treatment was associated with non-significant trends to reduced number of PEX (10 versus 14 with no RTX, p=0.30) and lower total CYC dose (3.3g versus 3.6g, p=0.78), with reduced time to anti-GBM negativity (2.1 versus 3.5 months with no RTX, p=0.67). In the Cox-proportional hazards regression model incorporating age, sex, ANCA status, dialysis need at presentation, lung haemorrhage, CYC and RTX treatment, increasing age was associated with risk of death (HR 1.07 [95% CI 1.01-1.17]) and risk of infection (HR 1.03 [95% CI 1.00-1.06]). Dialysis need at presentation was associated with ESKD-risk (HR 0.05 [95% CI 0.01-0.14]). The addition of rituximab was not significantly associated with risk of death (HR 1.45 [0.38-6.93]), ESKD (HR 0.97 [0.50-1.91]) or infection 0.48 [0.23-1.02].
Conclusion
Addition of RTX to standard treatment for anti-GBM disease was not associated with improved renal or overall survival. However, RTX use permitted lower cumulative doses of CYC and reduction in the number of PEX, without an increased risk of infection. RTX may have a role as a CYC- and PEX-sparing treatment in patients with anti-GBM disease.