Rituximab offers the same benefits as cyclophosphamide in the treatment of vasculitis, according to research presented on Sunday, Oct. 18, 2009 at the American College of Rheumatology Annual Scientific Meeting in Philadelphia, Pennsylvania.

Vasculitis refers to inflammation of blood vessels. There are multiple types of vasculitis. Most types of vasculitis are rare, their causes are generally unknown, and treatment is challenging. ANCA-associated vasculitis is caused by an overreaction of the immune system to many organ systems of the body (a systemic autoimmune disease). There are several types of ANCA-associated vasculitis, including Wegener’s granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome.

Combined use of cyclophosphamide and glucocorticoids has been the standard of care for induction of remission of ANCA-associated vasculitis for decades. Some studies have suggested that rituximab (Rituxan®) may be an effective alternative to cyclophosphamide for treating the disease while avoiding some of the side effects, such as low white blood counts, infections, irritation of the bladder, infertility and others caused by the standard therapy.

Researchers recently set out to compare the effectiveness of rituximab to cyclophosphamide in 197 patients with severe Wegener’s granulomatosis or microscopic polyangiitis.

They divided the participants into two groups; 99 participants on rituximab, of which 85 percent completed the study; and 98 participants on cyclophosphamide, of which 83 percent completed the study. The goal was to get each participant into remission and off prednisone.

Researchers found that 64 percent of the participants on rituximab experienced disease remission, compared to 55 percent of participants on the combination therapy. In addition, 71 percent of patients taking rituximab dropped their BVAS/WG (a composite measure of vasculitis disease activity) to zero and their prednisone (steroid) medication down to under 10 mg/day. This only occurred in 62 percent of the patients in the cyclophosphamide treatment group.

It was also noted that there were no differences between the two groups regarding the rates of disease flares and renal treatment response. Additionally, the rates of side effects were similar among the two groups, but fewer patients in the rituximab group experienced one or more selected severe side effects.

“This study proves that for patients with severe ANCA-associated vasculitis (Wegener’s granulomatosis and microscopic polyangiitis) there is finally an effective and well tolerated alternative to cyclophosphamide,” explains Ulrich Specks, MD; Mayo Clinic, Rochester, Minn., and lead investigator in the study.

Patients should talk to their rheumatologists to determine their best course of treatment.

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases.

Reprinted with permission from American College of Rheumatology

http://www.rheumatology.org/press/2009/2009_am_22.asp