Rituximab for induction and maintenance therapy of granulomatosis with polyangiitis: a single-centre cohort study on 114 patients

Puéchal, Xavier; Iudici, Michele; Calich, Ana Luisa; Vivot, Alexandre; Terrier, Benjamin; Régent, Alexis; Cohen, Pascal; Jeunne, Claire Le; Mouthon, Luc; Ravaud, Philippe; Guillevin, Loı̈c

doi:10.1093/rheumatology/key117

Cited by 40 publications

(31 citation statements)

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“…In refractory and relapsing cases of ocular involvement, RTX constituted an important therapeutic tool, being finally required in almost two thirds of refractory ocular manifestations and more than a half of all relapsing ocular symptoms, not only for controlling vasculitis (scleritis/conjunctivitis/optic ischemic neuritis), but also in some cases of granulomatous involvement such as orbital disease. Previous reports have observed less frequent remission in patients with granulomatous manifestations such as retroorbital granuloma and endobronchial disease treated with RTX [34][35][36], but recent trials have also demonstrated the usefulness of RTX in controlling such manifestations [37,38]. The overall prognosis of ANCA-associated vasculitides has improved [39] and actually, no patient in our series required debulking or decompression orbital surgery, thanks to the control of orbital disease with rescue treatment with RTX.…”

Section: Discussionmentioning

confidence: 62%

264. ocular Involvement in Granulomatosis With Polyangiitis: A Single-Center Cohort Study on 63 Patients

et al. 2019

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Section: Discussionmentioning

confidence: 62%

264. ocular Involvement in Granulomatosis With Polyangiitis: A Single-Center Cohort Study on 63 Patients

et al. 2019

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“…In our study, no vasculitis characteristic at baseline was associated with obtaining SROT or its persistence, including ENT and cardiovascular involvements that have been associated with increased risk of GPA relapses (21,22). Conversely, renal involvement, which is associated with a lower GPA relapse rate (23), does not seem to impact reaching or maintaining SROT.…”

Section: Discussionmentioning

confidence: 68%

Sustained Remission of Granulomatosis With Polyangiitis After Discontinuation of Glucocorticoids and Immunosuppressant Therapy: Data From the French Vasculitis Study Group Registry

Puéchal

Iudici

Pagnoux

et al. 2021

Arthritis & Rheumatology

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Objective. Data on sustained remission of granulomatosis with polyangiitis (GPA) after discontinuation of therapy (referred to as GPA with sustained remission off-therapy [SROT]) are scarce. In the present study, SROT among GPA patients from the French Vasculitis Study Group Registry was evaluated to identify factors associated with its occurrence and durability. Methods. For inclusion of patients in the study, the diagnosis of GPA had to meet the GPA classification criteria defined by the American College of Rheumatology and/or the revised Chapel Hill Consensus Conference nomenclature for vasculitis. SROT was defined as achievement of remission (a Birmingham Vasculitis Activity Score of 0) that was sustained for ≥6 consecutive months after having discontinued glucocorticoid (GC) and immunosuppressant treatments. The characteristics of the patients at baseline and treatments received were compared at 3, 5, and 10 years postdiagnosis according to whether or not SROT had been reached and maintained. Results. Among 795 patients with GPA, 92 GPA patients with SROT at 3 years postdiagnosis were compared to 342 control subjects who had experienced disease relapse and/or were still receiving GCs or immunosuppressants. No baseline differences were found, but patients with SROT at 3 years postdiagnosis had more frequently received intravenous cyclophosphamide as induction therapy compared to control subjects (P = 0.01), with a higher median number of infusions (P = 0.05). At 5 years postdiagnosis, no baseline differences were observed between groups, but patients with SROT at 5 years postdiagnosis had received more cyclophosphamide infusions compared to control subjects (P = 0.03). More patients with SROT had received rituximab as maintenance therapy than control subjects at 3 years and 5 years postdiagnosis (P = 0.09 and P < 0.001, respectively). Of the 74 patients enrolled in the GPA Registry with 10-year follow-up data after having received conventional maintenance therapy, 15 (20%) had reached SROT at 3 years, and 5 (7%) maintained SROT at 10 years postdiagnosis. Conclusion. After conventional therapies, 7% of GPA patients had reached SROT at 10 years postdiagnosis. No baseline vasculitis characteristics distinguished patients who achieved/maintained SROT from those who experienced disease relapse and/or those who continued to receive GCs or immunosuppressant therapy, but patients with SROT had received more intensive induction therapy and rituximab as maintenance therapy more frequently.

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“…In cases of autoimmune and/or idiopathic etiology, adjuvant medical treatment in terms of topical steroid injections or even systemic immunosuppressive therapy [ 37 – 39 ] is strongly recommended after surgical treatment and/or mechanical dilatations. In a recent Polish study, such a therapeutic triad resolved the stenosis after only one procedure in 68.9% of patients [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Transoral management of adult benign laryngeal stenosis

Incandela

Missale

Mora

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Management of benign laryngeal stenosis (BLS) remains challenging even though transoral treatments in selected cases have shown satisfactory results, at least comparable to open-neck approaches, with reduced invasiveness. To date, no overall consensus has been reached on many issues. The aim of this study is to assess the effectiveness of a purely transoral treatment in a cohort of patients affected by BLS. Methods We evaluated 40 patients affected by BLS, treated by transoral surgery between 2013 and 2017. The European Laryngological Society classification for laryngotracheal stenosis was applied for the staging. Improvement in airway patency and quality of life was assessed by decannulation rate, Airway-Dyspnea-Voice-Swallowing (ADVS) score, Voice handicap index (VHI)-30, and Eating assessment tool (EAT)-10 questionnaires. Results Mean age was 61 years and M:F ratio was 1.4:1. Previous laryngeal surgery was the most common cause of stenosis (50%), followed by radiotherapy (20%), idiopathic etiology (12%), granulomatosis with polyangiitis (10%), and prolonged intubation (8%). Transoral treatment entailed an improvement in quality of life with a significant decrease in the VHI score ( p < 0.0001) and improvement in Airway ( p = 0.008), Dyspnea (p < 0.0001), and Voice ( p < 0.0001) scores. No major perioperative complications were observed. The decannulation rate among patients with a tracheostomy in place ( N = 16) was 63%. Conclusions Transoral treatment of selected BLS managed by a team with high-level expertise in surgery and anesthesiology is associated with significant improvement of quality of life, especially with regard to voice and breathing functions. Electronic supplementary material The online version of this article (10.1007/s00405-020-06210-5) contains supplementary material, which is available to authorized users.

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Rituximab for induction and maintenance therapy of granulomatosis with polyangiitis: a single-centre cohort study on 114 patients

Abstract: RTX induction and low-dose preemptive maintenance can effectively and safely induce sustained remission in GPA in a real-life setting.

Cited by 40 publications

References 25 publications

264. ocular Involvement in Granulomatosis With Polyangiitis: A Single-Center Cohort Study on 63 Patients

264. ocular Involvement in Granulomatosis With Polyangiitis: A Single-Center Cohort Study on 63 Patients

Sustained Remission of Granulomatosis With Polyangiitis After Discontinuation of Glucocorticoids and Immunosuppressant Therapy: Data From the French Vasculitis Study Group Registry

Transoral management of adult benign laryngeal stenosis

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