AB0786 INDUCTION THERAPY WITH RITUXIMAB ENABLES SUSTAINED REMISSION IN ELDERLY PATIENTS WITH RELAPSED ANCA-ASSOCIATED VASCULITIS: A RETROSPECTIVE ANALYSIS FROM J-CANVAS, A JAPANESE MULTICENTRE-COHORT

Genki Kidoguchi ,Y Shimojima,T Kawaguchi,N Takizawa,Y Yasuhiko,S Omura,D Nakagomi,T Takata,T Takeuchi,T Yanagida,T Ito-Ihara,Yoshihisa Abe ,Masumi Kato ,Sho Mokuda ,Naomi Kondo ,Nobuyuki Yajima ,Yuki Kawasaki ,Ryo Yanai ,Masumi Kadoya ,Kunihiko Matsui ,Yoshia Miyawaki ,Kunihiro Ichinose ,Yusuke Yoshida ,Takashi Kida ,Hirotaka Watanabe ,Makoto Moriyama ,Ryo Okazaki ,Ryo Nishioka ,Akihiro Nomura ,Yoshimi Matsuo ,Yutaka Kawahito ,Kei Endo ,Ayuko Takatani ,Toshitsugu Sugimoto ,Toshiki Ito ,Shintaro Hirata

doi:10.1136/annrheumdis-2023-eular.2439

Abstract

BackgroundRituximab (RTX) is widely used in both remission induction and maintenance therapy for the new-onset ANCA-associated vasculitis (AAV)[1]. However, few studies have reported the efficacy and safety of RTX against relapsed AAV, especially in elderly patients.ObjectivesTo clarify the effectiveness and safety of RTX as a remission induction therapy after relapse in elderly AAV.MethodsWe retrospectively extracted elderly (≥65 years) patients who relapsed granulomatosis with polyangiitis or microscopic polyangiitis and received remission induction therapy from J-CANVAS, a Japanese multicentre-cohort. The main exposure was the usage of RTX in the therapy. Clinical and laboratory variables at relapse and complete remission (CR) rates at week 24 and 48 after starting induction therapy were compared between patients treated with RTX (RTX group) and those with the other conventional immunosuppressive therapies (non-RTX group). The primary outcome was the CR rates at week 24, which was defined as Birmingham Vasculitis Activity Score (BVAS) version3 = 0. In addition, we performed a multivariate logistic regression analysis after adjusting for the potentially confounding factors of age, AAV-subtype, and ANCA-serotype. Patients whose data were missing at week 24 or 48 were treated as non-CR.ResultsA total of 71 patients were enrolled; 30(42%) in RTX group and 41(58%) in non-RTX group. Baseline characteristics were comparable between two groups as shown in Table1. The median age was 74 vs. 76 years with the PR3-ANCA positivity rate of 23% vs. 17%, and the median BVAS score was 11 vs. 12 points, respectively. The CR rate at week 24 was higher in the RTX group than in the non-RTX group [21(70.0%) vs 27(65.8%), p = 0.308)] and that at week 48 was significantly higher in the RTX-group [24(80.0%) vs 19(46.3%), p = 0.004)] (shown in Figure 1), with comparable doses of concomitant glucocorticoids. The adjusted odds ratios of RTX use for CR at week 24 and 48 were 1.09 (95%CI 0.38-3.10) and 4.01 (95%CI1.29-12.30). The incidence of serious infection was similar in both groups: [4(13.3%) vs 4(9.8%), p=0.638)].ConclusionRTX may be superior, with well tolerability, to the other conventional immunosuppressive therapies as an induction therapy in elderly patients with relapsed AAV.

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