Rituximab for maintenance of remission in ANCA-associated vasculitis: Expert consensus guidelines - Executive summary

Tieu, Joanna; Smith, Rona; Basu, Neil; Brogan, Paul; D’Cruz, David; Dhaun, Neeraj; Flossmann, Oliver; Harper, Lorraine; Jones, Rachel B.; Lanyon, Peter C.; Luqmani, Raashid A.; McAdoo, Stephen P.; Mukhtyar, Chetan; Pearce, Fiona A.; Pusey, Charles D.; Robson, Joanna C.; Salama, Alan D.; Smyth, Lucy; Watts, Richard A.; Willcocks, Lisa C.; Jayne, David R. W.

Abstract

© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) encompasses three disease phenotypes: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Considerable improvements in therapy mean induction of remission occurs in most patients with AAV [1-4]. However, disease relapse continues to pose a burden to patients. Morbidity accrues with relapses through disease-related damage and adverse effects of therapies to manage these relapses, negatively impacting on quality of life [5]. Rituximab (RTX), a monoclonal antibody targeting CD20, leads to peripheral B cell depletion. This has been successfully trialled, and is licensed, for the induction and maintenance of remission in AAV [2, 3]. RTX is increasingly being used for the maintenance of remission in patients with AAV, to reduce the risk of relapse and its consequences [6]. Other commonly used agents that have been trialled for the maintenance of remission in AAV include azathioprine, methotrexate and mycophenolate [7-9]. The decision to select RTX for the maintenance of remission is multifactorial, including but not limited to, patient-related factors and preferences, previous treatment and response, consideration of the overall risk of relapse, and access to therapy. These guidelines have been developed by a group of physicians practising in the UK.

• Journal Article Type: Article
• Acceptance Date: Nov 19, 2019
• Online Publication Date: Feb 24, 2020
• Publication Date: Apr 1, 2020
• Deposit Date: May 15, 2020
• Publicly Available Date: Feb 25, 2021
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Issue: 4
• Pages: 727-731
• DOI: https://doi.org/10.1093/rheumatology/kez632
• Keywords: Pharmacology (medical); Rheumatology
• Public URL: https://uwe-repository.worktribe.com/output/5975247