Long-Term Safety of Rituximab in Granulomatosis With Polyangiitis and in Microscopic Polyangiitis

Peter A Merkel, John L Niles, Lester E Mertz, Patricia B Lehane, Pooneh Pordeli, Félix Erblang, Peter A Merkel, John L Niles, Lester E Mertz, Patricia B Lehane, Pooneh Pordeli, Félix Erblang

Abstract

Objective: The present study was undertaken to conduct a phase IV, open-label, prospective study to characterize the long-term safety of rituximab in a 4-year observational registry of adult patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) within the US.

Methods: Patients initiating treatment with rituximab were evaluated every 6 months for up to 4 years. Outcomes included the incidence of serious adverse events (SAEs), infusion-related reactions (IRRs), and SAEs of specific interest, including serious infections, serious cardiac events, serious vascular events, and malignancies.

Results: Overall, 97 patients (72 with GPA and 25 with MPA) received rituximab through a median of 8 (range 1-28) infusions and were followed up for a median of 3.94 years (range 0.05-4.32 years). The estimated incidence rates (95% confidence interval [95% CI]) of serious infections, serious cardiac events, and serious vascular events were 7.11 (4.55-10.58), 5.03 (2.93-8.06), and 2.37 (1.02-4.67) per 100 patient-years (PYs), respectively. No IRRs or SAEs occurred within 24 hours of an infusion of rituximab. None of the 9 deaths reported (crude mortality rate 2.67 [95% CI 1.22-5.06] per 100 PYs) were considered to be related to use of rituximab.

Conclusion: The safety profile of long-term treatment with rituximab in patients with GPA or MPA was consistent with that of rituximab administered for shorter durations and with rituximab's known safety profile in other autoimmune diseases for which it has received regulatory approval. These findings provide clinicians with long-term, practice-level safety data for rituximab in the treatment of GPA or MPA.

Trial registration: ClinicalTrials.gov NCT01613599.

© 2020 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.

Figures

Figure 1
Figure 1
Study patient disposition. RaVeR = Rituximab in ANCA‐Associated Vasculitis registry; * = 3 patients from an unresponsive study site were excluded because the data could not be verified; † = 3 patients had unspecified reasons for discontinuation.
Figure 2
Figure 2
Overall incidence rates of serious adverse events among patients in the study.
Figure 3
Figure 3
Incidence rates of specific serious adverse events (SAEs).

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Source: PubMed

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