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Thiel, J; Rizzi, M; Engesser, M; Dufner, AK; Troilo, A; Lorenzetti, R; Voll, RE; Venhoff, N.
B cell repopulation kinetics after rituximab treatment in ANCA-associated vasculitides compared to rheumatoid arthritis, and connective tissue diseases: a longitudinal observational study on 120 patients.
ARTHRITIS RES THER. 2017; 19(1): 101 Doi: 10.1186/s13075-017-1306-0 [OPEN ACCESS]
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Leading authors Med Uni Graz: Thiel Jens
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Abstract:: BACKGROUND: B cell depletion with rituximab (RTX) is approved for treatment of rheumatoid arthritis (RA) and ANCA-associated vasculitides (AAV). Recently, RTX has been shown to be effective in AAV maintenance therapy, but an optimal RTX treatment schedule is unknown and the time to B cell repopulation after RTX has not been studied. METHODS: Retrospective single-center analysis of B cell repopulation in patients with AAV, RA or connective tissue disease (CTD) treated with RTX. RESULTS: Beginning B cell repopulation within the first year after RTX treatment was observed in 93% of RA and 88% of CTD patients. Only 10% of patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) and no patient with eosinophilic granulomatosis with polyangiitis (EGPA) showed B cell repopulation within this time. Median time of B cell depletion was 26 months in GPA/MPA, and 21 months in EGPA compared to 9 months in RA, and 8 months in CTD (p < 0.0001). In 25 AAV-patients B cell depletion lasted for at least 44 months. There was a significant decline in serum immunoglobulin concentrations in GPA/MPA patients, but not in patients with RA or CTD. Significantly more GPA/MPA patients developed hygogammaglobulinemia (IgG <7 g/L) compared to patients with RA or CTD. CONCLUSIONS: In contrast to RA and CTD, in AAV RTX induces long-lasting depletion of B cells that is associated with decreased antibody production. This observation points toward potential defects in the B cell compartment in AAV that are unmasked by immunosuppressive treatment and has important implications for the design of maintenance treatment schedules using RTX.
Find related publications in this database (using NLM MeSH Indexing): Adult - administration & dosage; Aged - administration & dosage; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy, immunology, metabolism; Antirheumatic Agents - pharmacology, therapeutic use; Arthritis, Rheumatoid - drug therapy, immunology, metabolism; B-Lymphocytes - drug effects, immunology, metabolism; Connective Tissue Diseases - drug therapy, immunology, metabolism; Female - administration & dosage; Follow-Up Studies - administration & dosage; Humans - administration & dosage; Longitudinal Studies - administration & dosage; Male - administration & dosage; Middle Aged - administration & dosage; Retrospective Studies - administration & dosage; Rituximab - pharmacology, therapeutic use; Treatment Outcome - administration & dosage
Find related publications in this database (Keywords): ANCA; B lymphocyte; Rituximab; Repopulation; Hypogammaglobulinemia