Granulomatous Polyangiitis Refractory to Induction With Rituximab in 3 Patients.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Nouran Eshak, Grace Ehikhueme, Malvika Ramesh, John Pixley
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引用次数: 0

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides are a group of immune-mediated diseases characterized by inflammation of small vessels, leading to endothelial injury with subsequent tissue damage. Current guidelines recommend induction therapy with rituximab over cyclophosphamide for severe disease activity. In this case series-based review, the authors discuss 3 cases of granulomatosis with polyangiitis (GPA) with proteinase-3 (PR3) disease that deteriorated following induction therapy with rituximab combined with mycophenolate mofetil and high-dose steroids. All 3 patients subsequently required salvage therapy with cyclophosphamide. Our experience suggests there is a temporal window where induction with rituximab is not fully effective, and deterioration or death can ensue. Expert recommendations do not offer a preferential protocol for induction with either rituximab or cyclophosphamide, with some even using a combination of both.

3名患者的肉芽肿性多血管炎对利妥昔单抗诱导治疗无效
抗中性粒细胞胞浆抗体(ANCA)相关性血管炎是一组免疫介导的疾病,其特点是小血管发炎,导致内皮损伤,进而造成组织损伤。目前的指南建议,对于严重的疾病活动,使用利妥昔单抗而非环磷酰胺进行诱导治疗。在这篇基于病例系列的综述中,作者讨论了 3 例伴有蛋白酶-3(PR3)疾病的肉芽肿伴多血管炎(GPA)患者,他们在接受利妥昔单抗联合霉酚酸酯和大剂量类固醇诱导治疗后病情恶化。3 名患者随后都需要使用环磷酰胺进行挽救治疗。我们的经验表明,利妥昔单抗的诱导治疗并不完全有效,可能会出现病情恶化或死亡。专家建议并未提供利妥昔单抗或环磷酰胺的首选诱导方案,有些专家甚至将两者结合使用。
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来源期刊
CiteScore
1.90
自引率
0.00%
发文量
165
审稿时长
12 weeks
期刊介绍: The AFMR is committed to enhancing the training and career development of our members and to furthering its mission to facilitate the conduct of research to improve medical care. Case reports represent an important avenue for trainees (interns, residents, and fellows) and early-stage faculty to demonstrate productive, scholarly activity.
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