Rituximab appears to be effective in systemic rheumatoid vasculitis

Treatment with rituximab for systemic rheumatoid vasculitis (RV) results in complete remission (CR) in 62 percent of patients and partial response (PR) in 38 percent, a study has shown.

Medical charts of 17 patients (mean age, 59 years; 59 percent female) treated with rituximab for systemic RV from 2000 to 2017 were retrospectively reviewed. Analysis was performed on clinical characteristics, outcomes and adverse effects.

At RV diagnosis, 82 percent of patients had positive rheumatoid factor. Median Birmingham Vasculitis Activity Score for rheumatoid arthritis at the time of rituximab initiation was 4.0 (interquartile range, 2.0–7.5). Of the patients, eight (47 percent) presented with RV in the skin, two (12 percent) had mononeuritis multiplex, two (12 percent) experienced inflammatory ocular disease, and five (29 percent) had multiple organ systems affected by RV.

Rituximab was used for induction therapy in eight patients (47 percent), relapsing RV in four (24 percent), second-line therapy in two (12 percent), and salvage therapy or in combination with another medication in three (18 percent).

At 3 months, CR was achieved by two (13 percent) of 15 patients with available follow-up data and PR by 10 (67 percent). At 6 months, CR and PR were achieved by six (40 percent) and eight (53 percent) patients, whereas one showed no response. Eight (62 percent) of 13 patients with available records achieved CR and five (38 percent) had PR at 12 months.

“Further evidence is needed to inform treatment for patients with RV,” the authors said.