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Mescia, Federica; Salviani, Chiara; Tonoli, Mattia; Affatato, Stefania; Moratto, Daniele; Tedesco, Martina; Guerini, Alice; Gemmo, Alessia; Camoni, Marta; Delbarba, Elisa; Zubani, Roberto; Garrafa, Emirena; Chiarini, Marco; Gregorini, Gina; Scolari, Francesco; Alberici, Federico

Sustained post-rituximab B-cell depletion is common in ANCA-associated vasculitis and is affected by sex and renal function

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  • Medientyp: E-Artikel
  • Titel: Sustained post-rituximab B-cell depletion is common in ANCA-associated vasculitis and is affected by sex and renal function
  • Beteiligte: Mescia, Federica; Salviani, Chiara; Tonoli, Mattia; Affatato, Stefania; Moratto, Daniele; Tedesco, Martina; Guerini, Alice; Gemmo, Alessia; Camoni, Marta; Delbarba, Elisa; Zubani, Roberto; Garrafa, Emirena; Chiarini, Marco; Gregorini, Gina; Scolari, Francesco; Alberici, Federico
  • Erschienen: Oxford University Press (OUP), 2024
  • Erschienen in: Nephrology Dialysis Transplantation, 39 (2024) 4, Seite 683-693
  • Sprache: Englisch
  • DOI: 10.1093/ndt/gfad197
  • ISSN: 0931-0509; 1460-2385
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: ABSTRACT Objective Despite the increasing use of rituximab in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), it remains unclear what the optimal dosing is, especially for maintenance of remission. A deeper understanding of post-rituximab B-cell repopulation patterns may aid better-tailored treatment. Methods This is a monocentric, retrospective study including ANCA-positive AAV patients receiving a single course of rituximab induction. CD19+ B cells were longitudinally monitored with flow cytometry. B-cell repopulation was defined as CD19+ >10 cells/μL. Results Seventy-one patients were included, the majority with microscopic polyangiitis (75%), myeloperoxidase-ANCA positivity (75%) and with renal involvement (79%). During a median follow-up of 54 months since the first rituximab infusion, 44 patients (62%) repopulated B cells, with a median time to repopulation of 39 months (range 7–102). Patients experiencing B-cell depletion lasting longer than the overall median time to repopulation (39 months) exhibited a lower risk of flare and higher risk of serious infection. In multivariate Cox regression, higher estimated glomerular filtration rate (eGFR) [hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.13–2.98 per 30 mL/min/1.73 m2 eGFR] and female sex (HR 2.70, 95% CI 1.37–5.31) were independent predictors of increased rate of B-cell repopulation. Conclusion A subset of AAV patients develop sustained post-rituximab B-cell depletion, which associates with reduced risk of flare and increased risk of serious infection in the long term. Preserved renal function and female sex are associated with faster B-cell repopulation. These observations further highlight the need to personalize immunosuppression to improve clinical outcomes.