P48
5 YEAR FOLLOW UP OF ANCA ASSOCIATED VASCULITIS TREATED WITH
RITUXIMAB AS INDUCTION AGENT
N Naz1, T Roberts2, M Hiremath3, K Abdulnabi4,A Banerjee ,Yaser S
Wirral University Teaching Hospital
Introduction: There is limited longterm data on use of Rituximab (without cyclophosphamide
combination) as the primary /Induction agent in ANCA associated vasculitis (AAV). We looked
into 5 years follow up of new AAV patients treated with rituximab as the main induction agent
with Prednisolone (without cyclophosphamide combination),including 15 patients with serum
creatinine > 354µmol and 6 patients with lung haemorrhage not requiring ventilator support.
Our aim was to investigate the long term renal outcome in these patients and to identify rates of
infection, relapse, malignancy and survival .
Method:We retrospectively assessed 32 new AAV patients treated with Rituximab as an
induction agent without Cyclophosphamide.Serum creatinine at 3, 6, 12 months and 5 years of
presentation was compared with baseline serum creatinine. We also compared the presenting
creatinine above and below 354umol/l with baseline,3,6,12 months and 5 years. Incidence of
infection, mortality, malignancy, relapse rate and patient survival was assessed. COX regression
and multivariate regression analysis was used to assess the results.
Results :37% patients were female,60% patients presented with serum creatinine <500umol/l
and 40% >500umol/l. 19% i.e. 6 patients presented with lung Haemorrhage not requiring
artificial ventilation.C-ANCA was positive in 66% patient versus P-ANCA in 44%. 37.5 %
patients relapsed in 5 years follow up. 12 patients (37.5%) received plasma exchange based on
lung hemmorrhage and creatinine>500umol/l.
On multivariate linear regression;Creatinine at one year and 5 year follow up is only predicted
by creatinine at 3 months from starting treatment.,P=0.003,CI(0.280-1.22),(1.03-3.54)
respectively.Mean baseline creatininein lower creatinine group was 264.09 versus 179.82 at 5
years with p value of 0.16. Mean creatinine at 3 months was 132.55 versus 179.82 at 5 years
with p value of 0.003. Mean baseline creatinine in higher creatinine group was 469 versus 303
at 12 months with p value of 0.10. while mean baseline creatinine 469 and 3 monthly creatinine
was 255 with p value of 0.003. while mean creatinine at 12 months303 with 3 monthly 255 with
p value of 0.003. stability of creatinine between 12 months and 5 years indicate the efficacy of
rituximab in maintaining remission with less frequent relapses.
On COX regression analysis none of the factors as creatinine, ANCA status, pulmonary
haemorrhage, relapse, or gender predicted survival.
Age was a significant predictor for survival, EXP(B) 1.136(1.04-1.24) p=0.005
Over all median survival is 55+- 32 months.
47% patients died. 18% patient remained HD dependant, 47% were stable at CKD2-4. 12%
patients had severe sepsis mainly pneumonia and urosepsis. No malignancies were reported .
Conclusion:Rituximab is safe and effective treatment as an induction agent.
Renal outcome can be predicted at 3 months.
Age is a significant predictor of survival.