Long-term Outcomes of Rituximab Therapy in Ocular Granulomatosis with Polyangiitis

Joshi, Lavnish; Tanna, Anisha; McAdoo, Stephen P.; Medjeral-Thomas, Nicholas; Taylor, Simon; Sandhu, Gurpreet S.; Tarzi, Ruth M.; Pusey, Charles D.; Lightman, Sue

doi:10.1016/j.ophtha.2015.01.016

Cited by 55 publications

(21 citation statements)

References 35 publications

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“…Immunosuppressive therapy (with remission induction followed by remission maintenance) is almost always the initial treatment of choice for mass lesions (35,36). While these lesions tend to respond primarily to glucocorticoids, other agents are also usually used in hopes of having a glucocorticoid‐sparing effect.…”

Section: Resultsmentioning

confidence: 99%

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Chung

Langford

Maz

et al. 2021

Arthritis & Rheumatology

332

246

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Objective. To provide evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).Methods. Clinical questions regarding the treatment and management of AAV were developed in the population, intervention, comparator, and outcome (PICO) format (47 for GPA/MPA, 34 for EGPA). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel.Results. We present 26 recommendations and 5 ungraded position statements for GPA/MPA, and 15 recommendations and 5 ungraded position statements for EGPA. This guideline provides recommendations for remission induction and maintenance therapy as well as adjunctive treatment strategies in GPA, MPA, and EGPA. These recommendations include the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in nonsevere EGPA. All recommendations are conditional due in part to the lack of multiple randomized controlled trials and/or low-quality evidence supporting the recommendations.Conclusion. This guideline presents the first recommendations endorsed by the American College of Rheumatology and the Vasculitis Foundation for the management of AAV and provides guidance to health care professionals on how to treat these diseases.Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions, and drug formularies or other third-party analyses that cite ACR guidelines should state this. These recommendations cannot adequately convey all uncertainties and nuances of patient care.

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Section: Resultsmentioning

confidence: 99%

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Chung

Langford

Maz

et al. 2021

Arthritis & Rheumatology

332

246

View full text Add to dashboard Cite

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“…A review of the literature for studies of biologic therapy for scleritis revealed case reports and a randomized clinical trial of necrotizing scleritis treated with rituximab after immunosuppressive therapy, which achieved good responses (11,12) . Rituximab is a chimeric anti-CD20 monoclonal antibody that continues to increase in popularity for the treatment of ocular inflammatory diseases and intraocular lymphoma (13) .…”

Section: Discussionmentioning

confidence: 99%

Management of necrotizing scleritis after pterygium surgery with rituximab

Fidelix

Vieira

Trevisani

2016

Arquivos Brasileiros De Oftalmologia

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The authors present a case of necrotizing scleritis after pterygium excision successfully treated with rituximab after attempts with high doses of corticosteroids and immunosuppressive drugs. A literature review revealed case reports and a phase I/II dose-ranging randomized clinical trial using rituximab for necrotizing scleritis with or without association with autoimmune disease. This is the only case report on rituximab treatment for necrotizing scleritis after pterygium surgery. In cases with refractoriness to immunosuppressive drugs, a CD20 antibody can be used.

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“…In another study in 34 patients with mostly ENT involvement, response rate was as high as 88% and further increased after second dose of rituximab [82]. Another large (37 patients) single-center study in patients with orbital AAV demonstrated high response rate to rituximab (82% in patient with orbital masses), but also high relapse rate (51%), higher in patients with only localized ocular GPA [83]. Different response of granulomatous lesions in different studies and different localizations remains to be explained, and chronic infection (mostly Staphylococcus aureus), timing of intervention and doses and number of courses of rituximab may have a major impact on the response rate [84].…”

Section: Treatment Of Refractory Aavmentioning

confidence: 94%

Conventional induction and maintenance treatment of Antineutrophil cytoplasmic antibodies-associated vasculitis – still of value for our patients?

Tesař

Hrušková

2015

Expert Opinion on Pharmacotherapy

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Our analysis demonstrates that although the introduction of rituximab modified the approach to both the induction and maintenance treatment of AAV, more conventional induction and maintenance treatment with standard immunosuppressive drugs still retains its importance as we need more data on long-term efficacy and safety of biologic treatment, and also its cost-effectiveness still remains an open issue.

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Long-term Outcomes of Rituximab Therapy in Ocular Granulomatosis with Polyangiitis

Cited by 55 publications

References 35 publications

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Management of necrotizing scleritis after pterygium surgery with rituximab

Conventional induction and maintenance treatment of Antineutrophil cytoplasmic antibodies-associated vasculitis – still of value for our patients?

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