Thursday, 18 Oct 2018

You are here

Rituximab Efficacy in IgG4 Related Disease

PLOS reports  greater than 90% efficacy when rituximab (RTX) is used to treat patients with IgG4-related disease (IgG4-RD). 

The diagnosis and management of IgG4-RD is challenging and often without proven trial-based evidence.  A French national retrospective multicenter study examined the efficacy of RTX given to 33 patients with IgG4-RD. This RTX treated cohort was drawn from a total of 156 IgG4-RD patients in the French database.

A clinical response was noted in nearly all patients - 29/31 (93.5%) improved and steroid withdrawal was achieved in over half the patients (51.5%).

During a mean follow-up of 24 months, 13/31 (41.9%) of the RTX responding patients relapsed a mean of 19 months after RTX. 

Patients with active disease (IgG4-RD Responder Index >9) before RTX were more likely to relapse (HR = 3.68, 95% CI: 1.1, 12.6) (P = 0.04), whereas maintenance RTX therapy was associated with longer relapse-free survival (41 versus 21 months; P = 0.02). 

Important adverse effects included 8 serious infections in 4 patients (rate = 12.1/100 patient-years) and hypogammaglobulinemia was seen in 3 patients.

RTX is effective for both induction and maintenance therapy for IgG4-RD, but relapses are frequent after B-cell reconstitution. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

IL-6 for Adult Still's: A New Option?

Some clinical benefits were seen among patients with adult-onset Still's disease treated with tocilizumab (Actemra) in a small clinical trial, but the study's primary endpoint was not met, Japanese researchers reported.

Unproven But Profitable Stem Cell Clinics

Stem cell clinics are popular and proliferating as they are largely a cash business and fall outside of FDA regulatory control. In lieu of scientific proof, most advocates use patient testimonials and the placebo effect to back up their claims.

Out of Pocket Costs for Biosimilars - No Savings So Far

JAMA has published an analysis showing that under Medicare Part D, RA biosimilar infliximab-dyyb was only moderately less expensive (18% less) than the biologic infliximab and, owing to differences in gap discounts, the out of pocket costs for the biosimilar was nearly $1700 more than infliximab in 2017.

Cutting Oral JAK 1/2 Inhibitor Dose an Option in RA

Many patients with rheumatoid arthritis (RA) who achieved sustained disease control with baricitinib (Olumiant) treatment were able to reduce their daily dose from 4 mg to 2 mg and maintain their response, a double-blind substudy of a long-term extension trial found.

Tocilizumab Equals other Biologics in Cardiovascular Risk

An odd side effect of several new agents is the risk of hyperlipidemia. While this has been seen with tocilizumab (TCZ), there does not appear to be a resultant risk of cardiovascular (CV) events. A study of claims data compared CV risk in rheumatoid arthritis (RA) patients receiving TOC (an IL6 receptor antagonists) and other biologics and found no differences with regard to CV outcomes.