Rituximab, cyclophosphamide deliver similar effects on ENT symptoms in AAV

Cyclophosphamide (CYC) and rituximab (RTX) show comparable therapeutic effects on ear, nose, and throat (ENT) symptoms in patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV).

“Persistent ENT activity is a common feature despite immunosuppressive therapy,” the authors said.

This cohort study included 320 patients with AAV who were treated between January 2010 and April 2020 at two Dutch hospitals. The authors retrospectively collected clinical, histological, and laboratory data. They also assessed the association between therapy and ENT activity using logistic regression analysis.

ENT involvement was defined as one or more ENT symptoms according to the Birmingham Vasculitis Activity Score (version 3; BVAS3) or the presence of saddle nose deformity.

Of the eligible patients, 209 (65.3 percent; median age at disease onset, 52.0 years; 45.5 percent male) had ENT involvement at some point throughout the disease course. Median BVAS3 at diagnosis was 12.0.

Seventy-seven patients (50 percent) had ENT symptoms at relapse, and 59 (29.1 percent) had ENT activity at their last visit despite receiving immunosuppressive therapy.

Patients treated with oral or intravenous CYC (n=137) and those treated with RTX (n=55) showed no statistically significant difference in ENT activity at last visit (adjusted odds ratio, 0.59, 95 percent confidence interval, 0.33‒1.06; p=0.08).

In addition, lower age at disease onset and female sex showed independent associations with ENT activity at last follow-up.