WASHINGTON, D.C.—In 2011, rituximab was approved by the U.S. Food and Drug Administration for treatment in adults for two forms of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis—granulomatosis with polyangiitis (GPA; Wegener’s) and microscopic polyangiitis (MPA)—based on the results of the Rituximab for ANCA-Associated Vasculitis (RAVE) trial.1 Prior to rituximab, cyclophosphamide was used for many years as off-label treatment of these diseases and remains a viable option for a select group of patients, according to Carol Langford, MD, director of the Center for Vasculitis Care and Research at the Cleveland Clinic.
“We now have two effective options for remission induction of severe GPA/MPA, and that is great news for us and most importantly for our patients,” said Dr. Langford here at the 2012 ACR/ARHP Annual Meeting, held November 9–14. [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
Billed as “The Great Debate,” the session was a history lesson on the one hand, with Dr. Langford discussing the long years of experience, both personal and published, with cyclophosphamide; and, on the other hand, an overview of the current evidence establishing the role of rituximab as first-line therapy for remission induction in patients with severe disease by Ulrich Specks, MD, professor of medicine in the division of pulmonary and critical care medicine at the Mayo Clinic, Rochester, Minn.
Treatment Consensus on Some Patients
What emerged was an agreement that rituximab is the drug of choice in patients with severe disease relapse, as well as for those who have received prior treatment with cyclophosphamide.