Journal Article

Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis

Peikert, Tobias, Turkiewicz, Anthony, Stone, John H, Fervenza, Fernando C, Geetha, Duvuru, Hoffman, Gary S, Merkel, Peter A, Monach, Paul A, Sejismundo, Lourdes P, Allen, Nancy B, Stegeman, Coen, Mieras, Kathleen, Seyfert-Margolis, Vicki, Tchao, Nadia K, Weitzenkamp, David, Kissin, Eugene Y, Mueller, Mark, Seo, Philip, Kallenberg, Cees G.M, St. Clair, E. William, Keogh, Karina A, Specks, Ulrich, Ytterberg, Steven R, Langford, Carol A, Webber, Lisa, Spiera, Robert, Brunetta, Paul, Ikle, David, Ding, Linna

2010

Overview

This multicenter, randomized, double-blind, double-dummy, noninferiority trial compared rituximab with cyclophosphamide for remission induction in ANCA−associated vasculitis. Rituximab therapy was not inferior to daily cyclophosphamide treatment for remission induction in severe ANCA-associated vasculitis and may be superior in relapsing disease. Rituximab therapy was not inferior to daily cyclophosphamide treatment for remission induction in severe ANCA-associated vasculitis and may be superior in relapsing disease. Wegener's granulomatosis and microscopic polyangiitis are classified as antineutrophil cytoplasmic antibody (ANCA)−associated vasculitides because most patients with generalized disease have antibodies against proteinase 3 or myeloperoxidase. 1 , 2 The ANCA-associated vasculitides affect small-to-medium-size blood vessels, with a predilection for the respiratory tract and kidneys. 3 – 6 Cyclophosphamide and glucocorticoids have been the standard therapy for remission induction for nearly four decades. 7 , 8 This regimen transformed the usual treatment outcome of severe ANCA-associated vasculitis from death to a strong likelihood of disease control and temporary remission. 3 – 5 , 9 _ 11 However, not all patients have a remission with this combination of drugs, and those . . .

• Publisher: Massachusetts Medical Society
• Subject: Administration, Oral / Aged / Antibodies, Antineutrophil Cytoplasmic - blood / Antibodies, Monoclonal - adverse effects / Antibodies, Monoclonal - therapeutic use / Antibodies, Monoclonal, Murine-Derived / B-Lymphocytes - drug effects / Biological and medical sciences / Clinical trials / Cyclophosphamide - adverse effects / Cyclophosphamide - therapeutic use / Disease / Double-Blind Method / Drug Therapy, Combination / Female / General aspects / Glucocorticoids - adverse effects / Glucocorticoids - therapeutic use / Granulomatosis with Polyangiitis - drug therapy / Humans / Immunosuppressive Agents - adverse effects / Immunosuppressive Agents - therapeutic use / Intention to Treat Analysis / Lymphocytes / Male / Medical sciences / Methylprednisolone - therapeutic use / Microscopic Polyangiitis - drug therapy / Middle Aged / Neoplasms - epidemiology / Prednisone - therapeutic use / Quality of Life / Remission Induction / Rituximab / Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis