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Hadjadj J, Canzian A, Karadag O, Contis A, Maurier F, Sanges S, Sartorelli S, Denis L, de Moreuil C, Durel CA, Durupt S, Jachiet M, Rouzaud D, Salvarani C, Padoan R, Dagna L, Bonnet F, Agard C, Moulinet T, Hermet M, Sterpu R, Maria ATJ, Keraen J, Guillevin L, Jayne D, Terrier B. Use of biologics to treat relapsing and/or refractory polyarteritis nodosa: data from a European collaborative study. Rheumatology (Oxford) 2022; 62:341-346. [PMID: 35686919 DOI: 10.1093/rheumatology/keac332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To describe the effectiveness and safety of biologics for the treatment of relapsing and/or refractory polyarteritis nodosa (PAN). METHODS A retrospective European collaborative study was conducted in patients with PAN who received biologics for relapsing and/or refractory disease. RESULTS Forty-two patients with PAN received a total of 53 biologic courses, including TNF-α blockers in 15 cases, rituximab (RTX) in 18 cases, tocilizumab (TCZ) in 10 cases and other biologics in 10 cases. TNF-α blockers and TCZ were mainly used for refractory diseases whereas RTX was mainly initiated for relapsing disease. After a median follow-up of 29 (8-50) months, remission, partial response, treatment failure and treatment discontinuation due to severe adverse events occurred in, respectively, 40%, 13%, 40% and 7% of patients receiving TNF-α blockers, 50%, none, 30% and 20% of TCZ recipients, and 33%, 11%, 56% and none of the RTX recipients. No remission was noted in patients treated with other biologics. Severe adverse events were observed in 14 (28%) patients without significant differences between the three biologics, leading to early biologics discontinuation in only three cases. CONCLUSION These results suggest that TCZ may be effective in relapsing and/or refractory PAN. Our data warrant further study to confirm these findings.
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Affiliation(s)
- Jérome Hadjadj
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Canzian
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Anne Contis
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, Bordeaux
| | - François Maurier
- Department of Internal Medicine and Immunology, Groupe Hospitalier UNEOS, Metz-Vantoux
| | - Sébastien Sanges
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon
| | - Stéphane Durupt
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon.,Service de Médecine Interne, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite
| | | | - Diane Rouzaud
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carlo Salvarani
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrice Bonnet
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Saint André Hospital, Bordeaux
| | - Christian Agard
- Internal Medicine Department, Nantes Université, CHU Nantes, Nantes
| | - Thomas Moulinet
- Department of Internal Medicine and Clinical Immunology, Center de Compétence des Maladies Autoimmunes Systémiques Rares, CHU Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France; UMR 7365, IMoPA, University of Lorraine, CNRS, Nancy
| | - Marion Hermet
- Service de Médecine Interne, Centre Hospitalier, Vichy
| | - Raluca Sterpu
- Service de Médecine Interne, Immunologie Clinique, Médecine Aigüe Polyvalente, Hôpital Antoine-Béclère-AP-HP, Clamart
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine and Multiorgan Diseases, Referral Center for Auto-immune Diseases, Saint-Eloi Hospital Montpellier University, Montpellier
| | - Jérémy Keraen
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Loic Guillevin
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - David Jayne
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
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Trivioli G, Canzian A, Maritati F, Fenoglio R, Pillebout E, Urban ML, Mohammad A, Nogueira E, Silvestri E, Eriksson P, Segelmark M, Novikov P, Harris H, Smitienko I, Moiseev S, Farisogullari B, O'Sullivan D, Ponte C, Lamprecht P, Hocevar A, Karadag O, Little M, Emmi G, Jayne D, Mcadoo S, Roccatello D, Vaglio A. FC 039RENAL OUTCOME AFTER RITUXIMAB IN ADULT-ONSET IGA VASCULITIS AND CRESCENTIC IGA NEPHROPATHY: A MULTICENTRE STUDY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab117.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Glucocorticoids (GC) and/or immunosuppressive agents are the mainstay of therapy for adult-onset IgA Vasculitis (IgAV), but their efficacy is often partial while their toxicity is relevant. Recently, rituximab (RTX) has been reported as a safe and effective option but only few data on renal outcome are available.1 RTX has also been used in a few cases of crescentic IgA Nephropathy (cIgAN), an IgAN subset with vasculitic lesions and poor response to conventional immunosuppressive regimens.2 We present the results of a multicentre cohort of patients with IgAV and cIgAN treated with RTX.
Method
The databases of 16 consorted European centres were investigated to screen for patients with adult-onset, biopsy-proven IgAV and cIgAN (crescents in ≥25% glomeruli and rapid eGFR worsening at presentation), who received RTX as induction therapy. We selected patients with active renal manifestations at the time of RTX. Remission was defined as a Birmingham Vasculitis Activity Score (BVAS)=0 or <5 if it was due to persistent proteinuria and relapse as an increase in BVAS requiring change in immunosuppressive therapy.
Results
We identified 38 patients with IgAV and 12 patients with cIgAN who received RTX and had active renal involvement at the time of treatment. The median age at onset was 40 years (interquartile range, IQR, 25-53) and more than two-thirds of patients were male (Table 1). The median follow-up after RTX was 41 months (IQR 18-60).
Renal outcomes are reported in Table 2. At the time of treatment, 24 patients (48%) had eGFR ≥60 mL/min/1.73 m2. All had IgAV and their median BVAS was 17 (IQR 10-22). Furthermore, all had microhaematuria and proteinuria. Renal histology showed mesangial or focal endocapillary proliferation in 12/17 (71%) patients who underwent biopsy (class II-IIIA according to Pillebout3). Twenty patients (83%) achieved remission; after a median of 12 months (range 9-14), four experienced a minor relapse and one had a major relapse with significant renal disease progression. Renal function remained stable in all but two patients who developed end-stage renal disease (ESRD). Micro-haematuria subsided in 14/24 (58%) and median 24h proteinuria decreased from 1750 mg (IQR 865-3275) to 175 mg (IQR 100-800) at last follow-up (p=0.029).
Of the 26 patients with eGFR <60 mL/min/1.73 m2, 14 had IgAV and 12 had cIgAN. All were biopsied and 20 (77%) had diffuse endo/extra-capillary proliferation (classes IIIB-IV). Five patients required dialysis but recovered soon after treatment start. Remission was achieved by 16/26 (61%); eight (50%) subsequently relapsed and two (12%) reached ESRD. At last follow-up, eGFR was ≥60 mL/min/1.73 m2 in 8/26 (31%), 10/26 (48%) had stable renal function as compared to the time of RTX, while 8/26 (31%) had developed ESRD. Median 24h proteinuria decreased from 3400 mg (IQR 2150-6500) to 770 mg (177-1315) (p=0.016).
Remission rate and ESRD-free survival were respectively 86% and 92% in patients with IgAV, while they were respectively 42% and 42% in cIgAN patients. Furthermore, 21/24 (87%) patients who received RTX alone or combined to glucocorticoids but not to immunosuppressive agents achieved remission and 22/24 (92%) were ESRD-free at last follow-up. Of the 26 patients receiving immunosuppressive agents, 17 (65%) obtained remission and 18 (69%) were ESRD-free at last assessment. Over the whole follow-up, only one patient reported a severe adverse effect related to RTX (pneumonia).
Conclusion
Renal involvement in adult-onset IgAV and cIgAN is frequently severe. RTX, combined or not with other immunosuppressive agents, may improve renal manifestations and is well tolerated. IgAV patients show higher remission rates and a longer ESRD-free survival as compared to cIgAN patients.
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Affiliation(s)
- Giorgio Trivioli
- Meyer Children's Hospital, Nephrology and Dialysis Unit, Florence, Italy
| | - Alice Canzian
- Parma University Hospital, Obstetrics and Gynecologic Unit, Parma, Italy
| | | | - Roberta Fenoglio
- San Giovanni Bosco Hospital, Centre of Research of Rheumatologic, Nephrologic and Rare Diseases, Turin, Italy
| | - Evangeline Pillebout
- Sant-Louis Hospital and University Paris Diderot, Department for Nephrology, Paris, France
| | - Maria Letizia Urban
- University of Firenze, Department of Experimental and Clinical Sciences, Florence, Italy
| | - Aladdin Mohammad
- Lund University, Department of Rheumatology, Clinical Science , Lund, Sweden
| | - Estela Nogueira
- Centro Hospitalar Universitário Lisboa Norte, Division of Nephrology and Renal Transplantation, Lisboa, Portugal
| | - Elena Silvestri
- University of Firenze, Department of Experimental and Clinical Sciences, Florence, Italy
| | - Per Eriksson
- Linkoeping University, 10. Department of Medical and Health Sciences, Linkoping, Sweden
| | - Mårten Segelmark
- Linkoeping University, Department of Nephrology, Linkoping, Sweden
| | - Pavel Novikov
- Sechenov First Moschow State Medical University, Clinic of Nephrology, Internal and Occupational Diseases, Moscow, Russia
| | - Helen Harris
- Whyteman’s Brae Hospital, Rheumatology Unit, Kirkcaldy, United Kingdom
| | | | - Sergey Moiseev
- Sechenov First Moschow State Medical University, Clinic of Nephrology, Internal and Occupational Diseases, Moscow, Russia
| | | | | | - Cristina Ponte
- Lisbon Academic Medical Centre, Rheumatology, Lisboa, Portugal
| | - Peter Lamprecht
- University of Lübeck, Department of Rheumatology and Clinical Immunology, Lübeck, Germany
| | - Alojzija Hocevar
- University Medical Centre Ljubljana, Department of Rheumatology, Ljubljana, Slovenia
| | - Omer Karadag
- Hacetteppe University, Vasculitis Research Centre, Ankara, Turkey
| | - Mark Little
- Tallgath Hospital, Trinity Health Kidney Centre, Dublin, Ireland
| | - Giacomo Emmi
- University of Firenze, Department of Experimental and Clinical Sciences, Florence, Italy
| | - David Jayne
- University of Cambridge, Department of Medicine, Cambridge, United Kingdom
- Addenbrooke’s Hospital, Vasculitis and Lupus Clinic, Cambridge, United Kingdom
| | - Stephen Mcadoo
- Imperial College London, Centre for Inflammatory Disease, London, United Kingdom
| | - Dario Roccatello
- San Giovanni Bosco Hospital, Centre of Research of Rheumatologic, Nephrologic and Rare Diseases, Turin, Italy
- University of Turin, Centre of Research of Rheumatologic, Nephrologic and Rare Diseases, Turin, Italy
| | - Augusto Vaglio
- Meyer Children's Hospital, Nephrology and Dialysis Unit, Florence, Italy
- University of Florence, Department of Biomedical Experimental and Clinical Sciences, Florence, Italy
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Canzian A, Venhoff N, Urban ML, Sartorelli S, Ruppert AM, Groh M, Girszyn N, Taillé C, Maurier F, Cottin V, de Moreuil C, Germain V, Samson M, Jachiet M, Denis L, Rieu V, Smets P, Pugnet G, Deroux A, Durel CA, Aouba A, Cathébras P, Deligny C, Faguer S, Gil H, Godeau B, Lifermann F, Phin-Huynh S, Ruivard M, Bonniaud P, Puéchal X, Kahn JE, Thiel J, Dagna L, Guillevin L, Vaglio A, Emmi G, Terrier B. Use of Biologics to Treat Relapsing and/or Refractory Eosinophilic Granulomatosis With Polyangiitis: Data From a European Collaborative Study. Arthritis Rheumatol 2021; 73:498-503. [PMID: 33001543 DOI: 10.1002/art.41534] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/08/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To describe the efficacy and safety of biologics for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA). METHODS A retrospective European collaborative study was conducted in patients with EGPA who received treatment with biologics for refractory and/or relapsing disease. RESULTS Among the 147 patients with EGPA included in the study, 63 received rituximab (RTX), 51 received mepolizumab (MEPO), and 33 received omalizumab (OMA). At the time of inclusion, the median Birmingham Vasculitis Activity Score (BVAS) was 8.5 (interquartile range [IQR] 5-13) in the RTX group, while the median BVAS in the OMA group was 2 (IQR 1-4.5) and the median BVAS in the MEPO group was 2 (IQR 1-5). In patients receiving RTX, the median BVAS declined both at 6 months (median 1, IQR 0-4.5) and at 12 months (median 0, IQR 0-2), and the frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 49%, 24%, 24%, and 3%, respectively. For the treatment of glucocorticoid (GC)-dependent asthma, patients who received MEPO had a much better GC-sparing effect and overall response than did patients who received OMA. The frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 15%, 33%, 48%, and 4%, respectively, in the OMA group and 78%, 10%, 8%, and 4%, respectively, in the MEPO group. Remission rates at 12 months were 76% and 82% among patients receiving MEPO at a doses of 100 mg and 300 mg, respectively. CONCLUSION These results suggest that RTX could be effective in treating relapses of EGPA vasculitis. MEPO is highly effective with a good safety profile in patients with GC-dependent asthma. Our data suggest that 100 mg MEPO monthly could be an acceptable dosage for first-line therapy in selected instances of EGPA, recognizing, however, that this has not been compared to the validated dosage of 300 mg monthly.
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Affiliation(s)
- Alice Canzian
- National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Nils Venhoff
- University Medical Center Freiburg and University of Freiburg, Freiburg, Germany
| | | | - Silvia Sartorelli
- IRCCS San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Matthieu Groh
- National Referral Center for Hypereosinophilic Syndrome (CEREO), Hôpital Foch, Suresnes, France
| | | | - Camille Taillé
- Hôpital Bichat, AP-HP, Nord-Université de Paris, Centre de Référence des Maladies Pulmonaires Rares, INSERM UMR 1152, Paris, France
| | | | | | | | | | - Maxime Samson
- Centre Hospitalier Universitaire (CHU) de Dijon Bourgogne, Dijon, France
| | | | | | | | | | | | - Alban Deroux
- CHU de Grenoble Alpes, Hôpital Michallon, Grenoble, France
| | | | | | | | | | | | - Helder Gil
- Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | | | | | | | - Marc Ruivard
- CHU de Gabriel-Montpied, Clermont-Ferrand, France
| | - Philippe Bonniaud
- Centre de Référence des Maladies Pulmonaires Rares, CHU de Dijon Bourgogne, Université de Bourgogne, INSERM 1231, Dijon, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | | | - Jens Thiel
- University Medical Center Freiburg and University of Freiburg, Freiburg, Germany
| | - Lorenzo Dagna
- IRCCS San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Loïc Guillevin
- National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Augusto Vaglio
- Azienda Ospedaliero Universitaria Meyer and University of Florence, Florence, Italy
| | | | - Benjamin Terrier
- National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
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Abstract
Immunoglobulin A vasculitis (IgAV, formerly Henoch-Schönlein purpura) is a systemic inflammatory disease affecting small vessels. While it is common and usually benign in childhood, in adults it is rarer has a more severe course. Its main manifestations are cutaneous purpura, arthralgias or arthritis, acute enteritis and glomerulonephritis. Renal involvement is associated with a poor prognosis in adults. The treatment of adult-onset IgAV is still a matter of debate: although in patients with a non-severe phenotype remission can occur spontaneously, more severe cases may need immunosuppressive therapy. There are some areas of uncertainty with respect to the efficacy of immunosuppressive regimens: almost all data come from studies performed in children or from patients with IgA nephropathy and/or IgA-crescentic glomerulonephritis. The only randomised study performed in adults with IgAV and renal involvement showed that immunosuppressive therapy with cyclophosphamide did not improve renal outcome nor did it affect patient survival. The possible efficacy of other drugs is reported only in small case series. Recent evidences show that rituximab could be an effective therapeutic option for adult-onset IgAV, but this also needs to be confirmed in controlled trials. In this review, we focus on therapeutic options for adult-onset IgAV treatment, and discuss the main results of the studies performed so far.
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Affiliation(s)
| | - Alice Canzian
- Nephrology Unit, Parma University Hospital, Parma, Italy
| | | | - Augusto Vaglio
- Department of Biochemical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, and Meyer Children's Hospital, Firenze, Italy.
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Canzian A, Denis L, Ruppert A, Groh M, Taillé C, Rieu V, Smets P, Maurier F, Girszyn N, Samson M, De Moreuil C, Terrier B. Utilisation hors-AMM des biothérapies au cours de la granulomatose éosinophilique avec polyangéite réfractaire ou en rechute. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Favret E, Canzian A, Galdös J. Analysis of straight edges by means of gammametry / Analyse gradliniger Ränder mittels Gammamesstechnik. KERNTECHNIK 2000. [DOI: 10.1515/kern-2000-650116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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