ANCA-associated vasculitis and malignancy: Current evidence for cause and consequence relationships

Mahr, Alfred; Heijl, Caroline; Guenno, G. Le; Faurschou, Mikkel

doi:10.1016/j.berh.2012.12.003

Cited by 70 publications

(54 citation statements)

References 63 publications

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“…Whether RTX is a human carcinogen or not remains controversial. Patients with AAV already have an increased risk of developing malignancies (Pankhurst et al 2004;De Groot et al 2005), but there are reports that RTX does not induce carcinogenesis (Mahr et al 2013;Fleury et al 2016). Consequently, careful attention should be focused on monitoring the onset of malignancy and follow-up of patients with RTX-treated vasculitis.…”

Section: Discussionmentioning

confidence: 99%

Remission Induction Therapy with Rituximab for Microscopic Polyangiitis: A Feasibility Study

Saito¹,

Takeuchi²,

Kagaya³

et al. 2017

Tohoku J. Exp. Med.

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Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is systemic vascular inflammation. Microscopic polyangiitis (MPA) is a major type of AAV in Japan. MPA often affects the kidneys and lungs, leading to death if untreated. Induction therapy (i.e., initial treatment) for MPA has not been optimized, although methylprednisolone and cyclophosphamide are commonly used. Recently, rituximab (RTX) (a monoclonal antibody against the protein CD20) has also been used to treat refractory AAV. RTX at 375 mg/m 2 /week for 4 weeks (i.e., the conventional lymphoma dosing schedule) is used, but the optimal dosing schedule is controversial. Indeed, a single-dose of RTX successfully controlled nephrotic syndrome. However, to date, the effectiveness of a single RTX dose in treating MPA has not been fully investigated in Japan. This was a retrospective observational study. Six newly diagnosed patients with MPA were initially treated with methylprednisolone and a single dose of RTX (375 mg/m 2 ). We investigated the patients' clinical features, as well as the efficacy and safety of RTX treatment. All patients attained remission on a tapered prednisolone dose of < 10 mg/day during the first 12 months. One patient relapsed after 12 months whereas another required hospitalization owing to infective spondyloarthritis. Adverse reactions to RTX infusion and late-onset neutropenia were not observed. Therefore, a single-dose treatment with RTX induced remission with few complications, and allowed tapering the prednisolone treatment. We conclude that a single dose of RTX is a promising induction therapy for MPA, reducing the cost associated with multiple doses.

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Section: Discussionmentioning

confidence: 99%

Remission Induction Therapy with Rituximab for Microscopic Polyangiitis: A Feasibility Study

Saito¹,

Takeuchi²,

Kagaya³

et al. 2017

Tohoku J. Exp. Med.

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“…(2) increased chance of mutations and neoplastic transformation due to persistent triggering of immune system and hence cell replication [5]; (3) failure of the host immune surveillance consequential to the impaired immune function in autoimmune diseases, leading thereby to an increased propensity for cancer evasion and progression.…”

mentioning

confidence: 99%

Therapy-related acute myeloid leukemia in autoimmune diseases: caveats and pitfalls

Silva

2015

Int J Clin Pharm

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“…Increased risk of malignancy in AAV is related namely to the cumulative dose of cyclophosphamide [40]. Long-term risk of malignancy was 1.6 times higher in 535 AAV patients enrolled in 4 randomized controlled trials compared to the general population (possibly higher in patients with GPA compared to patients with microscopic polyangiitis [41]).…”

Section: Malignancymentioning

confidence: 99%

Limitations of Standard Immunosuppressive Treatment in ANCA-Associated Vasculitis and Lupus Nephritis

Tesař

Hrušková²

2014

Nephron Clin Pract

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Introduction of the standard immunosuppressive treatment has dramatically changed the outcome of patients with both ANCA-associated vasculitis and lupus nephritis, transforming them from incurable diseases with very high short-term mortality to chronic debilitating diseases with much lower short-term, but still relatively high long-term, morbidity/mortality. Long-term morbidity with damage accumulating partly due to the adverse events of the available treatment (namely gonadal toxicity, malignancy, bone disease, cataracts, diabetes, and thromboembolic and cardiovascular disease) has become a major concern. Although cyclophosphamide-based regimens have been partly replaced by newer agents in both ANCA-associated vasculitis and lupus nephritis (namely rituximab or mycophenolate, respectively) their short-term and medium-term adverse events may not be significantly less frequent and we can only hope that new treatments will translate into better long-term outcomes including better long-term safety.

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ANCA-associated vasculitis and malignancy: Current evidence for cause and consequence relationships

Cited by 70 publications

References 63 publications

Remission Induction Therapy with Rituximab for Microscopic Polyangiitis: A Feasibility Study

Remission Induction Therapy with Rituximab for Microscopic Polyangiitis: A Feasibility Study

Therapy-related acute myeloid leukemia in autoimmune diseases: caveats and pitfalls

Limitations of Standard Immunosuppressive Treatment in ANCA-Associated Vasculitis and Lupus Nephritis

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