(HealthDay News) – Repeated and prolonged use of rituximab for B-cell depletion to treat relapses or maintain remission is safe and effective in patients with refractory granulomatosis with polyangiitis (GPA; Wegener’s), a primary systemic small vessel vasculitis, according to a study published online June 21 in Arthritis & Rheumatism.

Rodrigo Cartin-Ceba, MD, from the Mayo Clinic in Rochester, MN, and colleagues examined the efficacy and safety of B-cell depletion in 53 patients with refractory GPA who had received at least two courses of rituximab for relapses or to remain in remission. All patients except one had antineutrophil cytoplasmic antibodies (ANCA) against proteinase 3 (PR3).

Patients received a median of four courses of rituximab treatment. The researchers found that B cells were depleted in all cases, returning after a median of 8.5 months. All relapses occurred after B cells were reconstituted, and all except one were accompanied or preceded by an increase in ANCA levels. There were infusion-related adverse events in 16 patients, and 30 infections required treatment when B cells were depleted.

“Rituximab [appears] effective and safe for induction and maintenance of remission in patients with relapsing GPA,” Cartin-Ceba and colleagues conclude. “Preemptive retreatment decisions can be individualized based on serial B lymphocyte and PR3-ANCA monitoring.”

Several authors disclosed being investigators on clinical trials supported by pharmaceutical companies, including Genentech, which manufactures rituximab.

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