FRI0289 THE CYCLOPHOSPHAMIDE-SPARING ROLE OF AN INTENSIFIED B-CELLS DEPLETION PROTOCOL IN ANCA-ASSOCIATED VASCULITIS. (June 2019)

• Record Type: Journal Article
• Authors: Roccatello, Dario; Sciascia, Savino; Fenoglio, Roberta; Rossi, Daniela
• Is Part Of: Annals of the rheumatic diseases. Volume 78(2019)Supplement 2
• Page Start: 825
• Page End: 825
• Publication Date: 2019-06
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2019-eular.4820
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: ANCA-associated vasculitis (AAV) are systemic diseases with relapsing chronic course. The management of AAV requires the use of immunosuppressive drugs whose use is associated with potential toxicity. Objectives: This case-control study aims to evaluate the immunosuppressive-sparing effect of rituximab (RTX) used with cyclophosphamide (CYC), compared to a traditional regimen based on high-dose CYC. Methods: 26 patients (pts) with AAV with a necrotising extracapillary glomerulonephritis were prospectively enrolled. 13 pts received the intensified protocol of B-lymphocyte depletion therapy (IBCDT) "4+2" with RTX and CYC (4 weekly infusions of RTX followed by 2 monthly followed by prednisone tapered to 5 mg/day in 3 months). 13 pts treated with the high-dose CYC treatment protocol followed by azathioprine as maintenance therapy were enrolled as controls. Results: In the 13 cases treated with the IBCDT we observed a significant reduction in mean values of parameter of disease activity. After administration of RTX, a significant reduction of the mean s-creatinine values and BVAS was observed. All pts had full B-cell depletion on peripheral blood after the first IBCDT protocol after 1 year. No further maintenance therapy was given. In the cases, a response was observed in 8/13 cases. 4 pts did not respond and a death was observed for cardiovascular causes. No significant difference was observed in terms of response to therapy between the two groups. The IBCDT allows a significant reduction in the cumulative dose of CYC to which each patient was exposed during follow-up, reaching statistical significance levels (p <0.001). Calculated on a monthly basis, the "4+2" protocol allowed an average reduction in the CYC cumulative dose equivalent to 827 mg/month. Conclusion: In a selected sample of patients with AAV with renal involvement, the IBCT regimen appeared to be non inferior in terms of the efficacy when compared to CYC-based standard regimens. Moreover, the IBCDT regimen allowed a net reduction in the cumulative average dose of CYC to which pts are exposed, quantifiable in approximately 1g/month. Disclosure of Interests: None declared