Background Cyclophosphamide (CYC) and corticosteroids (CS) are widely used in the treatment of ANCA-associated vasculitis (AAV). However, not all patients achieve remission and these drugs are associated with serious adverse events. New treatments like rituximab (RTX) have been proposed.
Objectives To systematically review the efficacy and safety of RTX in AAV.
Methods We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials up to October 2011 using a comprehensive search strategy for RTX, AAV, efficacy and safety (mesh terms and text words). Selection criteria were predefined by protocol. We selected meta-analysis, systematic literature reviews, clinical trials (CT), cohort studies and case series with >3 cases, that included >18 year-old patients with AAV on RTX. Studies including patients with Behçet disease, cryoglobulinemia, large vessel and secondary vasculitis, and basic science studies were excluded. Title and abstract selection and subsequent detailed review of selected articles were independently performed by two reviewers. The included studies quality was graded using the Oxford Levels of Evidence Scale, and results expressed as level of evidence (LE), recommendation grade (RG).
Results The search strategy identified 2,762 potentially relevant articles, of which 80 were selected for full paper review. Twenty-three articles were eventually included in the analysis and 2 identified by handsearch. The selection included 3 randomized CT, 2 open trials and 20 case series, which analyzed 638 patients. Main characteristics and results of the CT and the open studies are shown in the table. More than 70% of the 359 patients of the case series achieved remission after RTX treatment.
Conclusions RTX is not inferior to CYC regarding to the induction of remission in AAV (LE 1b; GR A), might be superior in relapsing disease (LE 1b; GR A), but showed no differences in sustained renal remission (LE 1b; GR A). Treatment with RTX leads to a safe CS tapering (LE 1b; GR A). RTX adverse events in AVV patients did not differ from those reported in other rheumatic diseases.
Disclosure of Interest None Declared
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