RT Journal Article
SR Electronic
T1 Rituximab-associated Vasculitis Flare: Incidence, Predictors, and Outcome
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 896
OP 902
DO 10.3899/jrheum.190076
VO 47
IS 6
A1 Anne Claire Desbois
A1 Lucie Biard
A1 Damien Sène
A1 Isabelle Brocheriou
A1 Philippe Rouvier
A1 Bertrand Lioger
A1 Lucile Musset
A1 Sophie Candon
A1 Thierry Zenone
A1 Matthieu Resche-Rigon
A1 Jean-Charles Piette
A1 Neila Benameur
A1 Patrice Cacoub
A1 David Saadoun
YR 2020
UL http://www.jrheum.org/content/47/6/896.abstract
AB Objective. To report the incidence, predictors, and outcome of rituximab (RTX)-associated autoimmune disease flare.Methods. We conducted a retrospective study in a tertiary referral center from 2005 to 2015. Disease flare was defined as the onset of a new organ involvement or worsening of autoimmune disease within 4 weeks following RTX.Results. Among the 185 patients, we identified 7 disease flares (3.4%). All were due to type II mixed cryoglobulinemia vasculitis. Vasculitis flare occurred after a median time of 8 days (range 2–16) following RTX infusion and included acute kidney insufficiency (n = 7), purpura with cutaneous (n = 7), gastrointestinal (GI) tract involvement (n = 4), and myocarditis (n = 1). Patients with RTX-associated cryoglobulinemia vasculitis flare had these conditions more frequently: renal involvement (p = 0.0008), B cell lymphoproliferation (p = 0.015), higher level of cryoglobulin (2.1 vs 0.4 g/l, p = 0.0004), and lower level of C4 (0.02 vs 0.05, p = 0.023) compared to patients without flare after RTX (n = 43). Four patients (57%) died after a median time of 3.3 months. The 1-year survival rate was poorer in patients with vasculitis flare after RTX compared to their negative counterpart [43% (95% CI 18–100) vs 97% (95% CI 92–100), p < 0.001]. Immunofluorescence analysis of kidney biopsy in patients with worsening RTX-associated vasculitis highlighted the presence of RTX-, IgM-, and IgG1-positive staining of endomembranous deposits and thrombi within kidney lesions.Conclusion. RTX-associated cryoglobulinemia vasculitis flare is associated with high mortality rate. We provided evidence that kidney lesions are due to immune complex deposition and to glomerular obstruction by cryoglobulinemia and RTX.