Rituxan Effective in Keeping ANCA Vasculitis at Bay, Saudi Study Shows

Rituxan (rituximab) effectively induces and maintains remission in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), a new Saudi study shows.

The study, “Systematic review of the role of rituximab in treatment of antineutrophil cytoplasmic autoantibody-associated vasculitis, hepatitis C virus-related cryoglobulinemic vasculitis, Henoch-Schönlein purpura, ankylosing spondylitis, and Raynaud’s phenomenon,” appeared in the journal Open Access Rheumatology: Research and Reviews.

The study’s senior author was Hani Almoallim of Jedda’s Dr. Soliman Fakeeh Hospital, and Mecca’s Umm Al-Qura University, both in Saudi Arabia.

Rituxan is commonly used to treat AAV and other chronic inflammatory conditions. The drug is a type of antibody therapy, which targets the CD20 protein — a surface marker that regulates the activation and proliferation of B-cells. Rituxan causes B-cell depletion and inhibits autoimmune responses.

Introducing the chemotherapy agent cyclophosphamide greatly improved AAV remission and reduced mortality, the study found. Other common medications for AAV are the immunosuppressant azathioprine and glucocorticoids (such as prednisolone), but a high number of relapses is still observed.

The Saudi scientists reviewed literature published between 2006 to 2016 on usingf Rituxan to treat AAV and other rheumatologic diseases. The data included diverse types of studies, such as randomized, controlled trials; case studies (detailed analyses of one patient); and case series (a series of case reports of patients with similar treatments).

Results demonstrate Rituxan’s efficacy in inducing disease remission in both newly diagnosed patients and following relapse. It was also effective in maintaining remission with associated B-cell depletion, especially compared to azathioprine in patients first treated with cyclophosphamide.

Of note, Rituxan treatment was also effective in patients with renal disease, and its use did not suggest significant toxicity.

“Further studies are required to confirm optimal maintenance regimens in AAV, protocol administration versus treatment in response to clinical relapse and the importance of maintaining B-cell depletion,” researchers wrote. Future work should also address how Rituxan may reduce the use of anti-inflammatory drugs and the immunosuppressive load.

Yet Rituxan’s safety in AAV still needs to be established due to the short follow-up of patients studied so far, the team observed.