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Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis.

Jones, Rachel B. ; Tervaert, Jan Willem Cohen ; Hauser, Thomas ; Luqmani, Raashid ; Morgan, Matthew D. ; Peh, Chen Au ; Savage, Caroline O. ; Segelmark, Mårten LU ; Tesar, Vladimir and van Paassen, Pieter , et al. (2010) In New England Journal of Medicine 363(3). p.211-220
Abstract
Background: Cyclophosphamide induction regimens for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis are effective in 70 to 90% of patients, but they are associated with high rates of death and adverse events. Treatment with rituximab has led to remission rates of 80 to 90% among patients with refractory ANCA-associated vasculitis and may be safer than cyclophosphamide regimens. Methods: We compared rituximab with cyclophosphamide as induction therapy in ANCA-associated vasculitis. We randomly assigned, in a 3:1 ratio, 44 patients with newly diagnosed ANCA-associated vasculitis and renal involvement to a standard glucocorticoid regimen plus either rituximab at a dose of 375 mg per square meter of body-surface area per week... (More)
Background: Cyclophosphamide induction regimens for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis are effective in 70 to 90% of patients, but they are associated with high rates of death and adverse events. Treatment with rituximab has led to remission rates of 80 to 90% among patients with refractory ANCA-associated vasculitis and may be safer than cyclophosphamide regimens. Methods: We compared rituximab with cyclophosphamide as induction therapy in ANCA-associated vasculitis. We randomly assigned, in a 3:1 ratio, 44 patients with newly diagnosed ANCA-associated vasculitis and renal involvement to a standard glucocorticoid regimen plus either rituximab at a dose of 375 mg per square meter of body-surface area per week for 4 weeks, with two intravenous cyclophosphamide pulses (33 patients, the rituximab group), or intravenous cyclophosphamide for 3 to 6 months followed by azathioprine (11 patients, the control group). Primary end points were sustained remission rates at 12 months and severe adverse events. Results: The median age was 68 years, and the glomerular filtration rate (GFR) was 18 ml per minute per 1.73 m(sup 2) of body-surface area. A total of 25 patients in the rituximab group (76%) and 9 patients in the control group (82%) had a sustained remission (P=0.68). Severe adverse events occurred in 14 patients in the rituximab group (42%) and 4 patients in the control group (36%) (P=0.77). Six of the 33 patients in the rituximab group (18%) and 2 of the 11 patients in the control group (18%) died (P=1.00). The median increase in the GFR between 0 and 12 months was 19 ml per minute in the rituximab group and 15 ml per minute in the control group (P=0.14). Conclusions: A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events. (Funded by Cambridge University Hospitals National Health Service Foundation Trust and F. Hoffmann-La Roche; Current Controlled Trials number, ISRCTN28528813.) N Engl J Med 2010;363:211-20. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
New England Journal of Medicine
volume
363
issue
3
pages
211 - 220
publisher
Massachusetts Medical Society
external identifiers
  • wos:000279864200004
  • scopus:77954632414
ISSN
0028-4793
DOI
10.1056/NEJMoa0909169
language
English
LU publication?
yes
id
7a1e199d-d368-4983-b246-bcc7c168d59b (old id 1657762)
alternative location
http://www.nejm.org/doi/full/10.1056/NEJMoa0909169
date added to LUP
2016-04-01 10:40:22
date last changed
2022-04-27 23:54:28
@article{7a1e199d-d368-4983-b246-bcc7c168d59b,
  abstract     = {{Background: Cyclophosphamide induction regimens for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis are effective in 70 to 90% of patients, but they are associated with high rates of death and adverse events. Treatment with rituximab has led to remission rates of 80 to 90% among patients with refractory ANCA-associated vasculitis and may be safer than cyclophosphamide regimens. Methods: We compared rituximab with cyclophosphamide as induction therapy in ANCA-associated vasculitis. We randomly assigned, in a 3:1 ratio, 44 patients with newly diagnosed ANCA-associated vasculitis and renal involvement to a standard glucocorticoid regimen plus either rituximab at a dose of 375 mg per square meter of body-surface area per week for 4 weeks, with two intravenous cyclophosphamide pulses (33 patients, the rituximab group), or intravenous cyclophosphamide for 3 to 6 months followed by azathioprine (11 patients, the control group). Primary end points were sustained remission rates at 12 months and severe adverse events. Results: The median age was 68 years, and the glomerular filtration rate (GFR) was 18 ml per minute per 1.73 m(sup 2) of body-surface area. A total of 25 patients in the rituximab group (76%) and 9 patients in the control group (82%) had a sustained remission (P=0.68). Severe adverse events occurred in 14 patients in the rituximab group (42%) and 4 patients in the control group (36%) (P=0.77). Six of the 33 patients in the rituximab group (18%) and 2 of the 11 patients in the control group (18%) died (P=1.00). The median increase in the GFR between 0 and 12 months was 19 ml per minute in the rituximab group and 15 ml per minute in the control group (P=0.14). Conclusions: A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events. (Funded by Cambridge University Hospitals National Health Service Foundation Trust and F. Hoffmann-La Roche; Current Controlled Trials number, ISRCTN28528813.) N Engl J Med 2010;363:211-20.}},
  author       = {{Jones, Rachel B. and Tervaert, Jan Willem Cohen and Hauser, Thomas and Luqmani, Raashid and Morgan, Matthew D. and Peh, Chen Au and Savage, Caroline O. and Segelmark, Mårten and Tesar, Vladimir and van Paassen, Pieter and Walsh, Dorothy and Walsh, Michael and Westman, Kerstin and Jayne, David R. W.}},
  issn         = {{0028-4793}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{211--220}},
  publisher    = {{Massachusetts Medical Society}},
  series       = {{New England Journal of Medicine}},
  title        = {{Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis.}},
  url          = {{http://dx.doi.org/10.1056/NEJMoa0909169}},
  doi          = {{10.1056/NEJMoa0909169}},
  volume       = {{363}},
  year         = {{2010}},
}