Rituximab treatment for IgA vasculitis: A systematic review

[EN]Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis for which treatment of severe cases is usually based on glucocorticoids and other conventional immunosuppressive drugs. The role of rituximab for resistant or refractory cases has been explored in isolated case reports and...

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Detalhes bibliográficos
Autores: Hernández Rodríguez, José, Carbonell Muñoz, Cristina, Mirón Canelo, José Antonio, Diez Ruiz, Sandra, Marcos Martín, Miguel, Chamorro Fernández, Antonio Javier
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Recursos:Universidad de Salamanca (USAL)
Repositorio:GREDOS. Repositorio Institucional de la Universidad de Salamanca
OAI Identifier:oai:gredos.usal.es:10366/168222
Acesso em linha:http://hdl.handle.net/10366/168222
Access Level:acceso abierto
Palavra-chave:Henoch-Schonlein purpura
IgA vasculitis
Rituximab
Treatment
Immunosuppressive Agents
Vasculitis
Immunoglobulin A
Treatment Outcome
Humans
resultado del tratamiento
humanos
inmunosupresores
vasculitis
inmunoglobulina A
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spelling Rituximab treatment for IgA vasculitis: A systematic reviewHernández Rodríguez, JoséCarbonell Muñoz, CristinaMirón Canelo, José AntonioDiez Ruiz, SandraMarcos Martín, MiguelChamorro Fernández, Antonio JavierHenoch-Schonlein purpuraIgA vasculitisRituximabTreatmentImmunosuppressive AgentsVasculitisImmunoglobulin ATreatment OutcomeHumansresultado del tratamientohumanosinmunosupresoresvasculitisinmunoglobulina A[EN]Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis for which treatment of severe cases is usually based on glucocorticoids and other conventional immunosuppressive drugs. The role of rituximab for resistant or refractory cases has been explored in isolated case reports and small series. To perform a literature review of all pediatric and adult patients with IgAV treated with rituximab (RTX) and to assess disease characteristics, RTX efficacy and safety. We conducted a systematic literature review according to PRISMA guidelines by selecting articles with information on IgAV and RTX up to October 2019. We extracted data on patient characteristics, disease course, RTX efficacy and tolerance. The resulting database was analyzed with statistical software package SPSS v 22.0. Among the initial 161 articles found, 20 studies including 35 well-characterized IgAV patients treated with RTX were finally analyzed. Distribution by sex was similar, and the median age at diagnosis was 26 (range: 2 months to 70 years). Patients included were equally diagnosed at pediatric age and in the adulthood. Almost 90% of patients had renal involvement before RTX treatment and resistant or refractory disease to glucocorticoids or other immunosuppressive agents, mainly with renal impairment, was the reason for RTX administration in 85.7% of patients. RTX was used because of contraindication to these previous agents in 8.6% of patients, and as first line therapy in 5.7% of them. With regard to RTX response, 94.3% of patients presented clinical improvement of any type and 74.3% achieved sustained remission at the end of follow-up. Among the 13 (37.1%) patients who experienced a disease relapse, 11 (31.4%) were treated with a new RTX dose, with good disease control in all cases. In terms of treatment requirements, glucocorticoids and additional immunosuppressants were significantly lower after RTX administration. No deaths were observed and the rate of minor RTX-associated adverse effects was of 8.6%. RTX seems to be a safe and useful agent in inducing disease remission and reducing previous immunosuppressive treatment in IgAV pediatric and adult patients resistant or refractory to glucocorticoids or other immunosuppressive drugs, and in those patients in whom these agents are contraindicated. Nevertheless, controlled clinical trials in are still warranted to clarify the role of RTX in IgAV.Elsevier202520252020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://hdl.handle.net/10366/168222reponame:GREDOS. Repositorio Institucional de la Universidad de Salamancainstname:Universidad de Salamanca (USAL)InglésAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:gredos.usal.es:10366/1682222026-06-07T06:28:51Z
dc.title.none.fl_str_mv Rituximab treatment for IgA vasculitis: A systematic review
title Rituximab treatment for IgA vasculitis: A systematic review
spellingShingle Rituximab treatment for IgA vasculitis: A systematic review
Hernández Rodríguez, José
Henoch-Schonlein purpura
IgA vasculitis
Rituximab
Treatment
Immunosuppressive Agents
Vasculitis
Immunoglobulin A
Treatment Outcome
Humans
resultado del tratamiento
humanos
inmunosupresores
vasculitis
inmunoglobulina A
title_short Rituximab treatment for IgA vasculitis: A systematic review
title_full Rituximab treatment for IgA vasculitis: A systematic review
title_fullStr Rituximab treatment for IgA vasculitis: A systematic review
title_full_unstemmed Rituximab treatment for IgA vasculitis: A systematic review
title_sort Rituximab treatment for IgA vasculitis: A systematic review
dc.creator.none.fl_str_mv Hernández Rodríguez, José
Carbonell Muñoz, Cristina
Mirón Canelo, José Antonio
Diez Ruiz, Sandra
Marcos Martín, Miguel
Chamorro Fernández, Antonio Javier
author Hernández Rodríguez, José
author_facet Hernández Rodríguez, José
Carbonell Muñoz, Cristina
Mirón Canelo, José Antonio
Diez Ruiz, Sandra
Marcos Martín, Miguel
Chamorro Fernández, Antonio Javier
author_role author
author2 Carbonell Muñoz, Cristina
Mirón Canelo, José Antonio
Diez Ruiz, Sandra
Marcos Martín, Miguel
Chamorro Fernández, Antonio Javier
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Henoch-Schonlein purpura
IgA vasculitis
Rituximab
Treatment
Immunosuppressive Agents
Vasculitis
Immunoglobulin A
Treatment Outcome
Humans
resultado del tratamiento
humanos
inmunosupresores
vasculitis
inmunoglobulina A
topic Henoch-Schonlein purpura
IgA vasculitis
Rituximab
Treatment
Immunosuppressive Agents
Vasculitis
Immunoglobulin A
Treatment Outcome
Humans
resultado del tratamiento
humanos
inmunosupresores
vasculitis
inmunoglobulina A
description [EN]Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis for which treatment of severe cases is usually based on glucocorticoids and other conventional immunosuppressive drugs. The role of rituximab for resistant or refractory cases has been explored in isolated case reports and small series. To perform a literature review of all pediatric and adult patients with IgAV treated with rituximab (RTX) and to assess disease characteristics, RTX efficacy and safety. We conducted a systematic literature review according to PRISMA guidelines by selecting articles with information on IgAV and RTX up to October 2019. We extracted data on patient characteristics, disease course, RTX efficacy and tolerance. The resulting database was analyzed with statistical software package SPSS v 22.0. Among the initial 161 articles found, 20 studies including 35 well-characterized IgAV patients treated with RTX were finally analyzed. Distribution by sex was similar, and the median age at diagnosis was 26 (range: 2 months to 70 years). Patients included were equally diagnosed at pediatric age and in the adulthood. Almost 90% of patients had renal involvement before RTX treatment and resistant or refractory disease to glucocorticoids or other immunosuppressive agents, mainly with renal impairment, was the reason for RTX administration in 85.7% of patients. RTX was used because of contraindication to these previous agents in 8.6% of patients, and as first line therapy in 5.7% of them. With regard to RTX response, 94.3% of patients presented clinical improvement of any type and 74.3% achieved sustained remission at the end of follow-up. Among the 13 (37.1%) patients who experienced a disease relapse, 11 (31.4%) were treated with a new RTX dose, with good disease control in all cases. In terms of treatment requirements, glucocorticoids and additional immunosuppressants were significantly lower after RTX administration. No deaths were observed and the rate of minor RTX-associated adverse effects was of 8.6%. RTX seems to be a safe and useful agent in inducing disease remission and reducing previous immunosuppressive treatment in IgAV pediatric and adult patients resistant or refractory to glucocorticoids or other immunosuppressive drugs, and in those patients in whom these agents are contraindicated. Nevertheless, controlled clinical trials in are still warranted to clarify the role of RTX in IgAV.
publishDate 2020
dc.date.none.fl_str_mv 2020
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10366/168222
url http://hdl.handle.net/10366/168222
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:GREDOS. Repositorio Institucional de la Universidad de Salamanca
instname:Universidad de Salamanca (USAL)
instname_str Universidad de Salamanca (USAL)
reponame_str GREDOS. Repositorio Institucional de la Universidad de Salamanca
collection GREDOS. Repositorio Institucional de la Universidad de Salamanca
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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