Management of severe renal disease in anti-neutrophil-cytoplasmic-antibody-associated vasculitis: the place of rituximab and plasma exchange?
Pauline Morel
(1)
,
Alexandre Karras
(2, 3)
,
Raphaël Porcher
(4, 5, 6)
,
Xavier Belenfant
(7)
,
Vincent Audard
(8, 9)
,
Cédric Rafat
(10)
,
Guillaume Hanouna
(11, 12)
,
Séverine Beaudreuil
(13)
,
Cédric Vilain
(14)
,
Aurélie Hummel
(15)
,
Benjamin Terrier
(16)
,
Evangeline Pillebout
(17)
,
Matthieu Groh
(18)
,
Romain Jouenne
(19)
,
Robin Dhote
(20)
,
Olivier Fain
(21)
,
Matthieu Ponsoye
(14)
,
Nicolas Noel
(22, 23)
,
Nicolas Limal
(24)
,
Xavier Puéchal
(25)
,
Claire Le Jeunne
(25, 26)
,
Loïc Guillevin
(25)
,
Luc Mouthon
(25)
,
Alexis Régent
(25)
1
AURA Paris - Plaisance
2 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
5 METHODS [CRESS - U1153 / UMR_A 1125] - Methods of therapeutic evaluation of chronic diseases | Méthodes de l’évaluation thérapeutique des maladies chroniques
6 Centre d'épidémiologie Clinique [Hôtel-Dieu]
7 CHI André Gregoire - Centre Hospitalier Intercommunal André Grégoire [Montreuil]
8 CHU Henri Mondor [Créteil]
9 IMRB - Institut Mondor de Recherche Biomédicale
10 CHU Tenon [AP-HP]
11 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
12 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
13 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
14 Hôpital Ambroise Paré [AP-HP]
15 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
16 IC UM3 (UMR 8104 / U1016) - Institut Cochin
17 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
18 Hôpital Foch [Suresnes]
19 CHU Pitié-Salpêtrière [AP-HP]
20 Hôpital Avicenne [AP-HP]
21 CHU Saint-Antoine [AP-HP]
22 Service de Médecine Interne - Immunologie Clinique [AP-HP Bicêtre]
23 IDMIT - Infectious Diseases Models for Innovative Therapies
24 Hôpital Henri Mondor
25 Hôpital Cochin [AP-HP]
26 UPCité - Université Paris Cité
2 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 CRESS (U1153 / UMR_A 1125) - Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques
5 METHODS [CRESS - U1153 / UMR_A 1125] - Methods of therapeutic evaluation of chronic diseases | Méthodes de l’évaluation thérapeutique des maladies chroniques
6 Centre d'épidémiologie Clinique [Hôtel-Dieu]
7 CHI André Gregoire - Centre Hospitalier Intercommunal André Grégoire [Montreuil]
8 CHU Henri Mondor [Créteil]
9 IMRB - Institut Mondor de Recherche Biomédicale
10 CHU Tenon [AP-HP]
11 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
12 CoRaKID - Maladies rénales fréquentes et rares : des mécanismes moléculaires à la médecine personnalisée
13 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
14 Hôpital Ambroise Paré [AP-HP]
15 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
16 IC UM3 (UMR 8104 / U1016) - Institut Cochin
17 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
18 Hôpital Foch [Suresnes]
19 CHU Pitié-Salpêtrière [AP-HP]
20 Hôpital Avicenne [AP-HP]
21 CHU Saint-Antoine [AP-HP]
22 Service de Médecine Interne - Immunologie Clinique [AP-HP Bicêtre]
23 IDMIT - Infectious Diseases Models for Innovative Therapies
24 Hôpital Henri Mondor
25 Hôpital Cochin [AP-HP]
26 UPCité - Université Paris Cité
Raphaël Porcher
- Fonction : Auteur
- PersonId : 756384
- ORCID : 0000-0002-5277-4679
- IdRef : 071086757
Vincent Audard
- Fonction : Auteur
Olivier Fain
- Fonction : Auteur
- PersonId : 1166060
- ORCID : 0000-0002-1974-3870
- IdRef : 069538476
Xavier Puéchal
- Fonction : Auteur
- PersonId : 756835
- ORCID : 0000-0003-3573-9203
- IdRef : 083261885
Loïc Guillevin
- Fonction : Auteur
- PersonId : 1171608
- ORCID : 0000-0001-6463-2160
- IdRef : 028285840
Luc Mouthon
- Fonction : Auteur
- PersonId : 1330915
- ORCID : 0000-0002-9838-246X
- IdRef : 069140634
Résumé
Abstract Objective The optimal induction therapy for severe glomerulonephritis of ANCA-associated vasculitis (AAV) is debated. We compared the efficacy of glucocorticoid and rituximab (RTX) or CYC induction therapy for severe AAV-related glomerulonephritis and evaluated the potential benefit of plasma exchange (PE) as adjunct therapy to CYC. Methods This retrospective, multicentre study included AAV patients with severe renal active disease (serum creatinine level ≥350 µmol/l and/or estimated glomerular filtration ratio ≤15 ml/min/1.73 m2). Propensity-score analysis was used to adjust for potential confounders. Results Between 2005 and 2017, 153 patients with AAV-related glomerulonephritis were studied (96 [60%] men; mean [s.d.] age 63 [13.1] years): 19 (12%) were treated with RTX and 134 (88%) with CYC. Remission rates did not differ between RTX- and CYC-treated groups. Although more patients with RTX than CYC were dialysis-free at month (M) 12 (79% vs 68%), the difference was not significant after adjustment. Among 134 patients with CYC-treated glomerulonephritis, 76 (57%) also had PE. M3 and M6 remission rates were comparable for weighted CYC groups with or without PE. For weighted groups, the dialysis-free survival rate with CYC was higher with than without PE at M6 (72% vs 64%; odds ratio 2.58) and M12 (74% vs 60%; odds ratio 2.78) reaching statistical significance at M12. Conclusion We could not find any difference between RTX and CYC as induction therapy for patients with severe AAV-related glomerulonephritis. In patients receiving CYC induction regimen, the addition of PE conferred short-term benefits with higher dialysis-free rate at M12.