Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg–Strauss)

Abstract

The treatment of EGPA with rituximab resulted in high rates of improvement and reduced requirement of prednisolone. Rituximab may be considered for the treatment of EGPA.

Updates in ANCA-associated vasculitis

“…However, more than half the patients will need to continue glucocorticoids because of persistent asthma or sinusitis. Data are limited for rituximab, but its use can be considered in refractory and/or relapsing cases (79,103). A randomized-controlled study from the French vasculitis study group should start soon to further determine its place in the therapeutic armamentarium for EGPA.…”

Immunotherapy in Eosinophilic Granulomatosis with Polyangiitis: A New Step Forward?

“…In the study reported by Muhammad et al, type and rate of response did not differ between the patients treated with rituximab 375 mg/m 2 for 4 weeks or with two doses of 1g given two weeks apart [24], as already shown in a retrospective study of patients with ANCAassociated vasculitis, of whom 5 had EGPA [27]. Apart infectious complications which may be severe in these immunocompromised patients already receiving glucocorticoids, other safety issues included infusion reactions in two patients requiring intubation due to worsening of asthma in one [24]. Severe bronchospasm has already been reported during the first 15 minutes of rituximab infusions in two EGPA patients [20].…”

“…Efficacy of rituximab therapy was significant in the vast majority of cases and in a wide variety of disease manifestations. The largest series to date has reported 41 EGPA patients, who received rituximab in four expert vasculitis centers, mostly for refractory or relapsing disease [24]. Patients with positive ANCA testing were significantly more likely to achieve remission at 12 months: 80% (12/15) who were ANCA-positive versus 36% (8/21) who were ANCA-negative.…”

“…Furthermore, recent case reports and small retrospective series [18][19][20][21][22][23][24][25] have indicated that rituximab may also be an effective remission induction agent in refractory or relapsing EGPA. A review of published series of rituximab for EGPA patients is shown in Table 1.…”

Eosinophilic granulomatosis with polyangiitis (formerly Churg–Strauss syndrome): where are we now?

“…Rituximab, a chimeric monoclonal antibody that targets B-lymphocytes, is now approved to induce GPA and MPA remissions [17], and has demonstrated effectiveness as maintenance [18]. Accumulating data on rituximab indicate that ANCA-positive EGPA patients seem to have higher remission rates than patients who are ANCA-negative [19]. To date, and although not licensed for EGPA, the task force suggests that using rituximab seems reasonable for ANCA-positive patients with renal involvement or severe refractory disease, for whom traditional cytotoxic agents are contraindicated or undesirable (e.g.…”