Keeping Vasculitis at Bay

Rituximab was safe and effective in preventing the return of ANCA associated vasculitis

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Certain diseases have a tendency to return even after they have been treated and controlled. For such conditions, medications that can fend off the disease as long as possible are usually preferred.

A certain type of vasculitis (inflammation of blood vessels) that can return after treatment can be treated effectively with rituximab (brand name Rituxan), says a new study.

According to this study, rituximab was as effective as standard treatment but required a simpler, shorter course of treatment. The medication also prevented the return of the disease for an extended period of time.

"Ask your doctor about new treatments for immune system diseases."

This study was conducted by John Stone, MD, of Massachusetts General Hospital, and Ulrich Specks, MD, from Mayo Clinic, and colleagues.

The aim of this study was to find out if one course of rituximab was as effective as the standard treatment for ANCA-associated vasculitis in preventing the disease from returning.

The study also compared the safety of rituximab to that of standard treatment over 18 months.

ANCA-associated vasculitis is a disease in which a person’s blood vessels are attacked by their own immune system, which can lead to kidney failure and sometimes even death. ANCA stands for "anti-neutrophil cytoplasmic antibody," which is the protein that does the damage.

Relapse (return of disease after previous treatment) is common in patients with ANCA-associated vasculitis.

The medication cyclophosphamide, along with a steroid, used to be the standard treatment for this type of vasculitis.

But cyclophosphamide can be very toxic to the body if used for a long period of time. This means that patients taking cyclophosphamide have to be monitored regularly for serious side effects.

Rituximab, a relatively newer medication, works by killing the specific immune cells that are attacking a patient’s own body.

Rituximab given with a steroid was previously shown to be as effective as cyclophosphamide given with a steroid to treat ANCA-associated vasculitis. The current study aimed to find out if rituximab therapy was safe and prevented relapse of the disease.

The researchers in the current study looked at 197 patients with severe ANCA-associated vasculitis who were randomly assigned to two groups.

Patients in the first group (100 patients) received one course of rituximab with steroids over four weeks and then were given an empty pill with no medication called a placebo through month 18.

Patients in the second group (97 patients) received three to six months of cyclophosphamide therapy with steroids followed by azathioprine until month 18.

Azathioprine, which is marketed under the brand names Imuran and Azasan, is another medication that prevents the immune system from attacking itself. Azathioprine can be toxic to the body as well.

At 18 months, the researchers found that 39 percent of the patients in the group that received rituximab hadn’t relapsed, compared to 33 percent of the patients who received cyclophosphamide. There was no significant difference in overall side effects between the two groups.

According to the researchers, these results suggest that a short course of rituximab over four weeks was as effective in treating and preventing the relapse of ANCA-associated vasculitis as the standard 18 month therapy.

One big limitation to this study, according to the researchers, was that they excluded patients who had non-severe ANCA-associated vasculitis or kidney damage. So it is not known whether rituximab will have similar effects on such patients.

The results of this study were published July 31 in the New England Journal of Medicine.

The study was sponsored by the ITN, a clinical trial network funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The study also received funding from biotechnology companies Genentech and Biogen. Genentech is the maker of rituximab.

Review Date: 
July 31, 2013
Last Updated:
August 1, 2013