April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Rituximab In Refractory Ophthalmic Wegener’s Granulomatosis: PR3 Titers Predict Relapse, But Repeat Treatment Is Effective
Author Affiliations & Notes
  • Lavnish Joshi
    Dept of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, United Kingdom
    Multidisciplinary Vasculitis Clinic, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Simon R. Taylor
    Dept of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, United Kingdom
    Multidisciplinary Vasculitis Clinic, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Alan Salama
    Multidisciplinary Vasculitis Clinic, Imperial College Healthcare NHS Trust, London, United Kingdom
    Centre for Nephrology, University College London, Royal Free Hospital, London, United Kingdom
  • Amy-Lee Shirodkar
    Dept of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, United Kingdom
  • Charles Pusey
    Multidisciplinary Vasculitis Clinic, Imperial College Healthcare NHS Trust, London, United Kingdom
    Renal Section, Division of Medicine, Imperial College, London, United Kingdom
  • Sue Lightman
    Dept of Clinical Ophthalmology, UCL Institute of Ophthalmology, London, United Kingdom
    Multidisciplinary Vasculitis Clinic, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Footnotes
    Commercial Relationships  Lavnish Joshi, None; Simon R. Taylor, None; Alan Salama, None; Amy-Lee Shirodkar, None; Charles Pusey, None; Sue Lightman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 4252. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : 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.

Methods: : 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.

Results: : 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.

Conclusions: : 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.

Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • inflammation • autoimmune disease 
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