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Asthma control in eosinophilic granulomatosis with polyangiitis treated with rituximab

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Abstract

Objectives

Rituximab (RTX) treatment is used for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis, but its benefits in eosinophilic granulomatosis with polyangiitis (EGPA) are unclear. Our aim was to characterize asthma control and glucocorticoid (GC) sparing after RTX treatment.

Methods

A retrospective, computer-assisted search was performed to identify patients with EGPA and GC-dependent asthma diagnosed between 2000 and 2017 who received RTX for remission induction. Demographic and clinical features were analyzed.

Results

Of the 17 patients included, the majority were myeloperoxidase-ANCA positive (n = 13, 76.5%). Uncontrolled asthma symptoms and atopy were present in 13 patients (76.5%). RTX was used for initial remission induction in patients with new onset of severe disease (n = 5, 29.4%) and after failed remission induction with other immunosuppression (n = 12, 70.6%). It was used for remission maintenance in nine patients (52.9%). GCs were used for maintenance at a median dose of 25 mg/day (interquartile range, 16.25–37.5). At the end of follow-up, 13 patients (76.5%) had non-severe or controlled asthma, and remission was achieved in 12 (70.6%). Median serum eosinophil and C-reactive protein values decreased (1.06 vs 0.10 × 109/L [P = .012] and 27.0 vs 5.0 mg/dL [P = .001], respectively), whereas pulmonary function test results remained unchanged. Median GC dose was significantly reduced at 6, 12, 18, and 24 months (P < .0001). Patients receiving RTX for maintenance required less than 10 mg of GCs for asthma control.

Conclusion

RTX seems to be safe and have GC-sparing efficacy for asthma control in EGPA. Randomized controlled trials are needed for detailed study of RTX for treating EGPA.

Key Points

• In this retrospective study we have concluded that rituximab (RTX) might be considered for the control of severe corticosteroid-dependent asthma in eosinophilic granulomatosis polyangiitis (EGPA) patients especially when myeloperoxidase antibodies are positive.

• Rituximab has not been studied particularly for asthma control in EGPA patients.

• The most noticeable effect of RTX was the decrease in the use of corticosteroids for the control of asthma.

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Abbreviations

ANCA:

Antineutrophil cytoplasmic antibody

BVAS/WG:

Birmingham Vasculitis Activity Score for Wegener Granulomatosis

EGPA:

Eosinophilic granulomatosis with polyangiitis

FEV1 :

Forced expiratory volume in the first second

FVC:

Forced vital capacity

GC:

Glucocorticoid

IQR:

Interquartile range

RTX:

Rituximab

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Marta Casal Moura, Alvise Berti, Karina A. Keogh, Ulrich Specks & Misbah Baqir

  2. Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA

    Gerald W. Volcheck

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  1. Marta Casal Moura
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  2. Alvise Berti
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Correspondence to Misbah Baqir.

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Casal Moura, M., Berti, A., Keogh, K.A. et al. Asthma control in eosinophilic granulomatosis with polyangiitis treated with rituximab. Clin Rheumatol 39, 1581–1590 (2020). https://doi.org/10.1007/s10067-019-04891-w

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