Rituximab Use Increasing in Treatment of Pediatric Vasculitis

More children received cyclophosphamide than rituximab (57% vs. 21%), and 10% received a combination of both. However, the use of rituximab increased over time, notably beginning in 2011, one year after the 2010 landmark studies, says Dr. James. “We did see rituximab use was more common in hospitals that had a higher volume of ANCA vasculitis patients,” she says. “We viewed that as a marker of familiarity with treating patients. So the more patients they treated, the more likely they were to use rituximab.”

The researchers used mechanical ventilation and dialysis as surrogate markers for the severe disease manifestations of renal failure and respiratory failure. Roughly 15% of the study’s patients required dialysis, and 17% needed mechanical ventilation. Researchers found that 21% of the patients received plasma exchange and that its use was highly variable and associated with needing dialysis.

“The treatment of children with severe AAV is shifting from cyclophosphamide to rituximab, and their need for dialysis, mechanical ventilation and prolonged hospitalization remains common,” the article concluded. “Use of plasma exchange is highly variable.”

Going Forward

Dr. James says the study gives pediatricians “great understanding” of the illness severity and variability that exists in this pediatric population. “I think this research helps show other providers that yes, people are adopting rituximab, and it’s OK to do that,” she says.

“We have a lot of work to do in … figuring out what is best for kids so that people feel comfortable using these regimens,” she says. “Something needs to be done to treat these kids because they are so sick.”

Catherine Kolonko is a medical writer based in Oregon.

References

1. James KE, Xiao R, Merkel PA, et al. Variation in the treatment of children hospitalized with antineutrophil cytoplasmic antibody–associated vasculitis in the United States. Arthritis Care Res (Hoboken). 2017 Sep;69(9):1377–1383.
2. Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010 Jul 15;363(3):221–232.
3. Jones RB, Furuta S, Tervaert JW, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis: 2-year results of a randomized trial. Ann Rheum Dis. 2015 Jun;74(6):1178–1182.