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Tytuł pozycji:

A Personalized Rituximab Retreatment Approach Based on Clinical and B-Cell Biomarkers in ANCA-Associated Vasculitis.

Tytuł:
A Personalized Rituximab Retreatment Approach Based on Clinical and B-Cell Biomarkers in ANCA-Associated Vasculitis.
Autorzy:
Arnold J; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.
Vital EM; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Dass S; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Aslam A; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Rawstron AC; Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Savic S; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Emery P; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Md Yusof MY; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Źródło:
Frontiers in immunology [Front Immunol] 2022 Jan 12; Vol. 12, pp. 803175. Date of Electronic Publication: 2022 Jan 12 (Print Publication: 2021).
Typ publikacji:
Journal Article; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Original Publication: [Lausanne : Frontiers Research Foundation]
MeSH Terms:
Precision Medicine*
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*drug therapy
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*metabolism
B-Lymphocytes/*drug effects
B-Lymphocytes/*metabolism
Immunologic Factors/*therapeutic use
Rituximab/*therapeutic use
Aged ; Algorithms ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/etiology ; Biomarkers ; Clinical Decision-Making ; Disease Susceptibility ; Drug Therapy, Combination ; Female ; Humans ; Immunologic Factors/administration & dosage ; Immunologic Factors/adverse effects ; Male ; Middle Aged ; Prognosis ; Recurrence ; Retreatment ; Retrospective Studies ; Rituximab/administration & dosage ; Rituximab/adverse effects ; Treatment Outcome
References:
Arthritis Rheumatol. 2014 Nov;66(11):3151-9. (PMID: 25047592)
Blood. 2011 Feb 17;117(7):2275-83. (PMID: 21097674)
Arthritis Rheumatol. 2021 Aug;73(8):1366-1383. (PMID: 34235894)
Nephrol Dial Transplant. 2021 Jul 23;36(8):1408-1417. (PMID: 32601673)
Rheumatology (Oxford). 2014 Sep;53(9):1693-703. (PMID: 24729396)
Ann Rheum Dis. 2009 Dec;68(12):1827-32. (PMID: 19054820)
Arthritis Rheum. 2006 May;54(5):1390-400. (PMID: 16649186)
Arthritis Rheumatol. 2019 Nov;71(11):1812-1823. (PMID: 31131994)
Arthritis Rheum. 2013 Jan;65(1):1-11. (PMID: 23045170)
Arthritis Rheum. 2006 Aug;54(8):2377-86. (PMID: 16869000)
Arthritis Rheum. 2008 Oct;58(10):2993-9. (PMID: 18821683)
Clin J Am Soc Nephrol. 2014 Apr;9(4):736-44. (PMID: 24626432)
Ann Rheum Dis. 2017 Oct;76(10):1662-1668. (PMID: 28546260)
Rheumatology (Oxford). 2021 Mar 2;60(3):1491-1501. (PMID: 33141217)
Arthritis Rheum. 2012 Nov;64(11):3760-9. (PMID: 22729997)
N Engl J Med. 2014 Nov 6;371(19):1771-80. (PMID: 25372085)
Rheumatology (Oxford). 2014 Mar;53(3):532-9. (PMID: 24282319)
Nephrol Dial Transplant. 2008 Sep;23(9):3030-2. (PMID: 18586761)
PLoS One. 2012;7(5):e37626. (PMID: 22629432)
Ann Rheum Dis. 2018 Aug;77(8):1143-1149. (PMID: 29695500)
Ann Rheum Dis. 2017 Nov;76(11):1829-1836. (PMID: 28684557)
Arthritis Rheum. 2010 Sep;62(9):2625-32. (PMID: 20506353)
Orphanet J Rare Dis. 2020 Dec 29;15(Suppl 2):351. (PMID: 33372616)
Ann Rheum Dis. 2018 Aug;77(8):1150-1156. (PMID: 29724729)
Rheumatology (Oxford). 2014 Oct;53(10):1818-24. (PMID: 24831059)
J Rheumatol. 2010 May;37(5):1069-71. (PMID: 20439529)
N Engl J Med. 2004 Jun 17;350(25):2572-81. (PMID: 15201414)
Ann Rheum Dis. 2015 Sep;74(9):1734-8. (PMID: 25854586)
Arthritis Rheum. 2010 May;62(5):1273-9. (PMID: 20131284)
Arthritis Rheum. 2012 Nov;64(11):3770-8. (PMID: 22730028)
Arthritis Rheum. 2011 Oct;63(10):3038-47. (PMID: 21618204)
J Clin Pharmacol. 2007 Sep;47(9):1119-28. (PMID: 17766699)
Arthritis Rheum. 2006 Feb;54(2):613-20. (PMID: 16447239)
Rheumatology (Oxford). 2020 Apr 1;59(4):e24-e32. (PMID: 32096545)
Grant Information:
204825/Z/16/Z United Kingdom WT_ Wellcome Trust; DRF-2014-07-155 United Kingdom DH_ Department of Health; CS-2013-13-032 United Kingdom DH_ Department of Health
Contributed Indexing:
Keywords: B cell; cyclophosphamide; immunoglobulin; rituximab; vasculitis
Substance Nomenclature:
0 (Biomarkers)
0 (Immunologic Factors)
4F4X42SYQ6 (Rituximab)
Entry Date(s):
Date Created: 20220131 Date Completed: 20220223 Latest Revision: 20220223
Update Code:
20240105
PubMed Central ID:
PMC8789753
DOI:
10.3389/fimmu.2021.803175
PMID:
35095887
Czasopismo naukowe
Background: Time to relapse after rituximab for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is variable, and optimal retreatment strategy has remained unclear. In AAV following rituximab induction, the study objective was to evaluate clinical and B-cell predictors of relapse in order to develop a retreatment algorithm.
Methods: A retrospective observational study was conducted in 70 rituximab-treated ANCA-associated vasculitis patients followed up for over 10 years. Complete response (CR) was defined as Birmingham Vasculitis Activity Score v3.0 = 0. Retreatment was given on clinical relapse, defined as new features or worsening of persistent disease (not by biomarker status). Peripheral B-cell subsets were measured using highly sensitive flow cytometry. Predictors were tested using multivariable Cox regression.
Results: Median time to retreatment for cycles 1-5 were 84, 73, 67, 60, and 73 weeks. Over 467 patient-years follow-up, 158 relapses occurred in 60 patients; 16 (in 15 patients) were major (renal = 7, neurological = 4, ENT = 3, and respiratory = 2). The major-relapse rate was 3.4/100 patient-years. In multivariable analysis, concomitant immunosuppressant [HR, 0.48 (95% CI, 0.24-0.94)], achieving CR [0.24 (0.12-0.50)], and naïve B-cell repopulation at 6 months [0.43 (0.22-0.84)] were associated with longer time to relapse. Personalized retreatment using these three predictors in this cohort would have avoided an unnecessary fixed retreatment in 24% of patients. Area under the receiver operating characteristic for prediction of time to relapse was greater if guided by naïve B-cell repopulation than if previously evaluated ANCA and/or CD19 + cells return at 6 months had been used, 0.82 and 0.53, respectively.
Conclusion: Our findings suggest that all patients should be coprescribed oral immunosuppressant. Those with incomplete response or with absent naïve B cells should be retreated at 6 months. Patients with complete response and naïve repopulation should not receive fixed retreatment. This algorithm could reduce unnecessary retreatment and warrant investigation in clinical trials.
Competing Interests: SD has received honoraria from Roche and GSK. SS has received honoraria from Novartis, Swedish Orphan Biovitrum (SOBI), and Sire and grant support from Novartis, Swedish Orphan Biovitrum, Octapharma, and CSL Behring. EV has received honoraria and research grant support from Roche, GSK, and AstraZeneca. PE has received consultant fees from BMS, Abbott, Pfizer, MSD, Novartis, Roche, and UCB. He has received research grants paid to his employer from Abbott, BMS, Pfizer, MSD, and Roche. MYMY has received consultancy fees from Aurinia Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Arnold, Vital, Dass, Aslam, Rawstron, Savic, Emery and Md Yusof.)

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