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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1657762
- author
- 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. (More)
- 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
; van Paassen, Pieter
; Walsh, Dorothy
; Walsh, Michael
; Westman, Kerstin
LU
and Jayne, David R. W.
(Less)
- organization
- publishing date
- 2010
- type
- Contribution to journal
- publication status
- published
- subject
- in
- New England Journal of Medicine
- volume
- 363
- issue
- 3
- pages
- 211 - 220
- publisher
- Massachussetts 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
- 2025-04-04 14:16:48
@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 = {{Massachussetts 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}},
}