Although a high rate of serious infections can occur during induction therapy, rituximab is associated with better disease remission and relapse prevention among older adults with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, according to study findings published in JAMA Network Open.

Researchers conducted a multicenter cohort study that comprised 93 individuals (median age 79.4 years; 54.8% [n=51] women) with ANCA-associated vasculitis. Patient data were obtained from the French Vasculitis Study Group registry.

Among the study patients, 55.9% (n=52) were diagnosed with granulomatosis with polyangiitis and 44.1% (n=41) were diagnosed with microscopic polyangiitis. All study patients received rituximab therapy after the age of 75 years (rituximab induction therapy plus high-dose glucocorticoids, 32.3% [n=30]; rituximab maintenance therapy, 29.0% [n=27]; rituximab induction and maintenance therapy, 38.7% [n=36]).


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Remission occurrence, drug discontinuation, minor and major relapses, mortality, and serious infections were calculated. A Fisher exact or chi-squared test was used to compare categorical variables, and either a t-test or Mann-Whitney U test was used to compare continuous variables.

Follow-up occurred for a median of 2.3 years. Remission occurred among 86.4% (n=57) of the 66 patients in the rituximab induction therapy group, and the rate of relapse was 3.0% (n=2). The incidence rate of serious infections was significantly greater among those treated with rituximab as induction therapy (46.6 [95% CI, 24.8-79.7] per 100 patient-years) compared with maintenance therapy (8.4 [95% CI, 3.8-15.9] per 100 patient-years; P =.004).

Gram-negative bacterial infections comprised the majority of infections (54.5%; n=12 of 22). The incidence of mortality was 19.7 (95% CI, 7.2-42.9) per 100 patient-years in the induction therapy group and 5.3 (95% CI, 1.9-11.6) per 100 patient-years in the maintenance therapy group.

A limitation of the study was the lack of a control group.

The study authors conclude, “[M]ost patients [aged] 75 years and older who received rituximab therapy achieved sustained remission and did not experience relapse.” They indicate that serious infections occurred “when rituximab was used to induce remission in combination with high-dose glucocorticoid regimens,” and that further studies are needed to find “the best induction regimen to reduce infections without limiting benefits in this population.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Thietart S, Karras A, Augusto J, et al. Evaluation of rituximab for induction and maintenance therapy in patients 75 years and older with antineutrophil cytoplasmic antibody-associated vasculitis. JAMA Netw Open. 2022;5(7):e2220925. doi:10.1001/jamanetworkopen.2022.20925