Objective Otolaryngologic (ENT) involvement is the most prevalent manifestation of Granulomatosis with Polyangiitis (GPA) and correlates with permanent damage and decreased quality of life. Although prior studies have evaluated the efficacy of rituximab (RTX) for granulomatous features of GCA, none have evaluated its efficacy solely for ENT manifestations. We compared the efficacy of RTX to other therapies for the ENT manifestations of GPA.
Methods A retrospective analysis of 975 visits from 99 GPA patients seen at a tertiary care ENT practice between 2003 and 2013. At each visit subjects had complete ENT exam with ENT activity assessed by a single expert otolaryngologist. ENT disease activity at each visit in subjects on RTX was compared to those on all other therapy.
Results 48 subjects never received RTX and 51 received RTX at least once. There was no active ENT disease at 92.4% of visits for subjects on RTX compared to 53.7% of visits for subjects not receiving RTX (OR 11.0; 95% CI 5.5–22.0, p<0.0001). Subjects on RTX compared to methotrexate, azathioprine, cyclophosphamide or trimethoprim-sulfamethoxazole were significantly more likely to be in ENT remission, p<0.0001 for each comparison.
Conclusion RTX is an effective treatment for ENT manifestations of GPA. Subjects treated with RTX were significantly less likely to have active ENT disease compared to those not on RTX. Patients being treated with RTX were 11 times less likely to have active ENT disease than patients being treated with other therapies.