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dc.contributor.authorMcClure, Mark Een
dc.contributor.authorWason, Jamesen
dc.contributor.authorGopaluni, Seerapanien
dc.contributor.authorTieu, Joannaen
dc.contributor.authorSmith, Ronaen
dc.contributor.authorJayne, Daviden
dc.contributor.authorJones, Rachel Ben
dc.date.accessioned2019-04-12T23:31:12Z
dc.date.available2019-04-12T23:31:12Z
dc.date.issued2019-08en
dc.identifier.issn1076-1608
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/291575
dc.description.abstractINTRODUCTION: The value of antineutrophil cytoplasmic antibody (ANCA) measurements among patients with an established diagnosis of ANCA-associated vasculitis (AAV) to assess disease activity or predict relapse remains controversial, but recent evidence suggests a possible role for rituximab-treated patients. PATIENTS AND METHODS: All patients with active vasculitis and positive proteinase 3 (PR3)-ANCA who were starting a 2-year treatment course of rituximab for induction of remission at Addenbrooke's Hospital between January 2011 and January 2016 were included in this study. Common department practice consists of 6 g of rituximab given over 2 years, concomitant corticosteroids (0.5-1.0 mg/kg) with rapid taper over 3 months, and cessation of oral maintenance immunosuppressive agents at time of first rituximab dose. Clinical and laboratory data were collected retrospectively using electronic patient records. RESULTS: Fifty-seven patients with current PR3-ANCA positivity were included in the analysis. Median follow-up was 59 months. PR3-ANCA negativity was achieved in 25 patients (44%) with a median time of 14 months. Clinical remission was achieved in 53 patients (93%) with a median time of 3 months. Among the 53 patients who achieved remission during follow-up, 24 (45%) relapsed with a median time to relapse of 36 months from remission. Both PR3-ANCA-negative status and 50% reduction in PR3-ANCA from baseline (as time-varying covariates) were significantly associated with a longer time to relapse (PR3-ANCA-negative status: hazards ratio, 0.08 [95% confidence interval, 0.01-0.63, p = 0.016]; 50% reduction in PR3-ANCA: hazards ratio, 0.25 [95% confidence interval, 0.18-0.99, p = 0.046]). CONCLUSIONS: Achieving and maintaining PR3-ANCA negativity after rituximab was associated with longer-lasting remission.
dc.description.sponsorshipThis work was not funded by any particular research grant. M.M. is a PhD student in receipt of an MRC-GSK Experimental Medicine Initiative to Explore New Therapies (EMINENT) fellowship.
dc.format.mediumPrinten
dc.languageengen
dc.publisherWolters Kluwer
dc.rightsAll rights reserved
dc.rights.uri
dc.subjectHumansen
dc.subjectAntibodies, Antineutrophil Cytoplasmicen
dc.subjectImmunologic Factorsen
dc.subjectGlucocorticoidsen
dc.subjectEnzyme-Linked Immunosorbent Assayen
dc.subjectRemission Inductionen
dc.subjectMiddle Ageden
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectMyeloblastinen
dc.subjectAnti-Neutrophil Cytoplasmic Antibody-Associated Vasculitisen
dc.subjectBiomarkersen
dc.subjectRituximaben
dc.titleEvaluation of PR3-ANCA Status After Rituximab for ANCA-Associated Vasculitis.en
dc.typeArticle
prism.endingPage223
prism.issueIdentifier5en
prism.publicationDate2019en
prism.publicationNameJournal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseasesen
prism.startingPage217
prism.volume25en
dc.identifier.doi10.17863/CAM.38733
dcterms.dateAccepted2019-01-11en
rioxxterms.versionofrecord10.1097/rhu.0000000000001030en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2019-08en
dc.contributor.orcidWason, James [0000-0002-4691-126X]
dc.contributor.orcidGopaluni, Seerapani [0000-0002-1584-6186]
dc.contributor.orcidSmith, Rona [0000-0002-7438-5156]
dc.contributor.orcidJayne, David [0000-0002-1712-0637]
dc.contributor.orcidJones, Rachel B [0000-0003-4790-283X]
dc.identifier.eissn1536-7355
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idMRC (unknown)
rioxxterms.freetoread.startdate2020-03-20


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