BACKGROUND: Rituximab (RTX) is approved for remission induction in ANCA associated vasculitis (AAV). However, data on use of RTX in patients with severe renal disease is lacking. METHODS: We conducted a retrospective multi-center study to evaluate the efficacy and safety of RTX with glucocorticoids (GC) with and without use of concomitant cyclophosphamide (CYC) for remission induction in patients presenting with e GFR less than 20 ml/min/1.73 m(2). We evaluated outcomes of remission at 6 months (6 M), renal recovery after acute dialysis at diagnosis, e-GFR rise at 6 M, patient and renal survival and adverse events. RESULTS: A total 37 patients met the inclusion criteria. The median age was 61 years. (55-73), 62 % were males, 78 % had new diagnosis and 59 % were MPO ANCA positive. The median (IQR) e-GFR at diagnosis was 13 ml/min/1.73 m(2) (7-16) and 15 required acute dialysis. Eleven (30 %) had alveolar hemorrhage. Twelve (32 %) received RTX with GC, 25 (68 %) received RTX with GC and CYC and seventeen (46 %) received plasma exchange. The median (IQR) follow up was 973 (200-1656) days. Thirty two of 33 patients (97 %) achieved remission at 6 M and 10 of 15 patients (67 %) requiring dialysis recovered renal function. The median prednisone dose at 6 M was 6 mg/day. The mean (SD) increase in e-GFR at 6 months was 14.5 (22) ml/min/m(2). Twelve patients developed ESRD during follow up. There were 3 deaths in the first 6 months. When stratified by use of concomitant CYC, there were no differences in baseline e GFR, use of plasmapheresis, RTX dosing regimen or median follow up days between the groups. No differences in remission, renal recovery ESRD or death were observed. CONCLUSIONS: This study of AAV patients with severe renal disease demonstrates that the outcomes appear equivalent when treated with RTX and GC with or without concomitant CYC.

• MeSH
• ANCA-asociované vaskulitidy diagnóza   farmakoterapie   imunologie   mortalita   MeSH
• časové faktory MeSH
• chronické selhání ledvin imunologie   prevence a kontrola   MeSH
• cyklofosfamid terapeutické užití   MeSH
• dialýza ledvin MeSH
• glomerulonefritida diagnóza   farmakoterapie   imunologie   mortalita   MeSH
• glukokortikoidy terapeutické užití   MeSH
• hodnoty glomerulární filtrace účinky léků   MeSH
• imunosupresiva škodlivé účinky   terapeutické užití   MeSH
• indukce remise MeSH
• kombinovaná farmakoterapie MeSH
• kombinovaná terapie MeSH
• ledviny účinky léků   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• progrese nemoci MeSH
• retrospektivní studie MeSH
• rituximab škodlivé účinky   terapeutické užití   MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• výměna plazmy MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• srovnávací studie MeSH
• Geografické názvy
• Evropa MeSH
• Spojené státy americké MeSH