Long-term maintenance rituximab for ANCA-associated vasculitis: relapse and infection prediction models

作者：Mark McClure, Yajing Zhu, Rona Smith, Seerapani Gopaluni, Joanna Tieu, Tasneem Pope, Karl Emil Kristensen, David Jayne, Jessica Barrett, Rachel Jones · 发表于：Lara D. Veeken · 年份：2020 · DOI：10.1093/rheumatology/keaa541 · 被引用次数：40 · 研究领域：Vasculitis and related conditions、Otitis Media and Relapsing Polychondritis、Systemic Sclerosis and Related Diseases

OBJECTIVES: Following a maintenance course of rituximab (RTX) for ANCA-associated vasculitis (AAV), relapses occur on cessation of therapy, and further dosing is considered. This study aimed to develop relapse and infection risk prediction models to help guide decision making regarding extended RTX maintenance therapy. METHODS: Patients with a diagnosis of AAV who received 4-8 grams of RTX as maintenance treatment between 2002 and 2018 were included. Both induction and maintenance doses were included; most patients received standard departmental protocol consisting of 2× 1000 mg 2 weeks apart, followed by 1000 mg every 6 months for 2 years. Patients who continued on repeat RTX dosing long-term were excluded. Separate risk prediction models were derived for the outcomes of relapse and infection. RESULTS: A total of 147 patients were included in this study with a median follow-up of 63 months [interquartile range (IQR): 34-93]. Relapse: At time of last RTX, the model comprised seven predictors, with a corresponding C-index of 0.54. Discrimination between individuals using this model was not possible; however, discrimination could be achieved by grouping patients into low- and high-risk groups. When the model was applied 12 months post last RTX, the ability to discriminate relapse risk between individuals improved (C-index 0.65), and once again, clear discrimination was observed between patients from low- and high-risk groups. Infection: At time of last RTX, five predictors were...