| Title |
Long-term follow-up of a combined rituximab and cyclophosphamide regimen in renal anti-neutrophil cytoplasm antibody-associated vasculitis
|
|---|---|
| Published in |
Nephrology Dialysis Transplantation, February 2018
|
| DOI | 10.1093/ndt/gfx378 |
| Pubmed ID | |
| Authors |
Stephen P McAdoo, Nicholas Medjeral-Thomas, Seerapani Gopaluni, Anisha Tanna, Nicholas Mansfield, Jack Galliford, Megan Griffith, Jeremy Levy, Thomas D Cairns, David Jayne, Alan D Salama, Charles D Pusey |
| Abstract |
Current guidelines advise that rituximab or cyclophosphamide should be used for the treatment of organ-threatening disease in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV), although few studies have examined the efficacy and safety of these agents in combination. We conducted a single-centre cohort study of 66 patients treated with a combination of oral corticosteroids, rituximab and low-dose pulsed intravenous cyclophosphamide followed by a maintenance regimen of azathioprine and tapered steroid for the treatment of biopsy-proven renal involvement in AAV. Patients were followed for a median of 56 months. Case-control analysis with 198 propensity-matched cases from European Vasculitis Study Group (EUVAS) trials compared long-term differences in relapse-free, renal and patient survival. At entry, the median Birmingham Vasculitis Activity Score (BVAS) was 19 and estimated glomerular filtration rate was 25 mL/min. Cumulative doses of rituximab, cyclophosphamide and corticosteroids were 2, 3 and 4.2 g, respectively, at 6 months. A total of 94% of patients achieved disease remission by 6 months (BVAS < 0) and patient and renal survival were 84 and 95%, respectively, at 5 years. A total of 84% achieved ANCA-negative status and 57% remained B cell deplete at 2 years, which was associated with low rates of major relapse (15% at 5 years). The serious infection rate during long-term follow-up was 1.24 per 10 patient-years. Treatment with this regimen was associated with a reduced risk of death {hazard ratio [HR] 0.29 [95% confidence interval (CI) 0.125-0.675], P = 0.004}, progression to end-stage renal disease (ESRD) [HR 0.20 (95% CI 0.06-0.65), P = 0.007] and relapse [HR 0.49 (95% CI 0.25-0.97), P = 0.04] compared with propensity-matched patients enrolled in EUVAS trials. This regimen is potentially superior to current standards of care, and controlled studies are warranted to establish the utility of combination drug approaches in the treatment of AAV. |
X Demographics
The data shown below were collected from the profiles of 55 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 8 | 15% |
| United Kingdom | 7 | 13% |
| Mexico | 5 | 9% |
| India | 3 | 5% |
| Colombia | 2 | 4% |
| Canada | 2 | 4% |
| Uruguay | 1 | 2% |
| Egypt | 1 | 2% |
| Argentina | 1 | 2% |
| Other | 7 | 13% |
| Unknown | 18 | 33% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 33 | 60% |
| Practitioners (doctors, other healthcare professionals) | 10 | 18% |
| Scientists | 8 | 15% |
| Science communicators (journalists, bloggers, editors) | 3 | 5% |
| Unknown | 1 | 2% |
Mendeley readers
The data shown below were compiled from readership statistics for 124 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 124 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 16 | 13% |
| Researcher | 14 | 11% |
| Student > Postgraduate | 12 | 10% |
| Student > Doctoral Student | 11 | 9% |
| Student > Ph. D. Student | 11 | 9% |
| Other | 27 | 22% |
| Unknown | 33 | 27% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 76 | 61% |
| Biochemistry, Genetics and Molecular Biology | 3 | 2% |
| Immunology and Microbiology | 2 | 2% |
| Psychology | 1 | <1% |
| Agricultural and Biological Sciences | 1 | <1% |
| Other | 2 | 2% |
| Unknown | 39 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 35. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 November 2022.
All research outputs
#1,118,451
of 24,871,735 outputs
Outputs from Nephrology Dialysis Transplantation
#278
of 6,374 outputs
Outputs of similar age
#27,722
of 456,726 outputs
Outputs of similar age from Nephrology Dialysis Transplantation
#5
of 92 outputs
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