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Lavnish Joshi, Simon R. Taylor, Alan Salama, Amy-Lee Shirodkar, Charles Pusey, Sue Lightman; Rituximab In Refractory Ophthalmic Wegener’s Granulomatosis: PR3 Titers Predict Relapse, But Repeat Treatment Is Effective. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4252.
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The objective of this study is to report the long-term outcome of the treatment of refractory ophthalmic Wegener’s Granulomatosis (WG) with rituximab (RIT). We assessed relapse rates, predictors of relapse and the results of repeat treatment.
A retrospective review of 20 consecutive patients with refractory ophthalmic WG treated with RIT at a single multidisciplinary clinic. In all patients, the ophthalmic disease was driving treatment decisions, and disease activity had persisted despite standard immunosuppressive treatment. Patients had refractory scleritis (n=6), orbital granulomas causing optic nerve compromise (n=10), or a combination of both conditions (n=4). RIT was given intravenously as two doses two weeks apart, in combination with standard treatment.
All 20 patients entered remission, with the median time to remission being 2 months (range 1-6 months). Seven patients (35%) subsequently relapsed, with a median time to relapse of 13 months (range 9-18 months). Five patients had a second course of rituximab and they all achieved remission which was maintained for the time of follow up without further relapse. In the 16 patients with positive anti-PR3 titers at baseline, anti-PR3 titer was a statistically significant risk factor for relapse, with an odds ratio of 10.0 (95% CI 1.03 - 97.5). Three patients had severe adverse events during the course of the study, of which one infection was directly attributed to treatment with RIT.
In this relatively large series of 20 patients with refractory ophthalmic WG, RIT was effective in inducing remission. Relapse occurred in approximately a third of patients at about 12 months, and could be predicted by rising anti-PR3 titers, but retreatment with RIT was effective. RIT is capable of inducing extended remission in these patients, in contrast to other biological and conventional treatments in common use.
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