Rituximab may induce remission, allow glucocorticoid tapering in IgAV
Rituximab appears to be safe and effective in the treatment of patients with adult-onset IgA vasculitis (IgAV), inducing disease remission and allowing glucocorticoid tapering, according to a study.
The multicentre, observational study included 22 patients with adult-onset IgAV (formerly Henoch-Schönlein purpura) who had received rituximab for either refractory/relapsing disease or due to contraindications to conventional glucocorticoid/immunosuppressive therapy. The median follow-up was 24 months.
Researchers estimated the rates of remission (defined on the basis of the Birmingham Vasculitis Activity Score, BVAS) and relapse, as well as the variations over time in estimated glomerular filtration rate (eGFR), proteinuria, C-reactive protein levels, BVAS and prednisone dose.
Rituximab was given to 16 patients as add-on therapy and to six as monotherapy. Overall, 20 (90.9 percent) achieved remission and seven (35 percent) subsequently relapsed. Rituximab treatment led to a significant reduction in 24 hour-proteinuria (p<0.0001), C-reactive protein (p=0.0005), BVAS (p<0.0001) and prednisone dose (p<0.0001). Moreover, eGFR remained stable.
In terms of safety, treatment was well tolerated. There was one patient who died after 60 months of follow-up.
Researchers noted that while the use of rituximab in IgAV may potentially reduce the proliferation of IgA-producing plasma cells or deplete tissue-infiltrating B-cells, “its therapeutic efficacy most likely results from the impairment of other B-cell functions such as antigen-presentation and T-cell costimulation, as already postulated in ANCA-associated vasculitis and other autoimmune conditions.” [Nephrol Dial Transplant 2013;29:1151–59]