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Study: Treatment for antibody-associated vasculitis is shifting from cyclophosphamide to rituximab
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Children hospitalized with severe antineutrophil cytoplasmic antibody-associated vasculitis are increasingly treated with rituximab rather than cyclophosphamide, and these patients frequently continue to need dialysis, mechanical ventilation and prolonged hospitalization, according to recently published findings.
In the retrospective cohort study, researchers evaluated 1,290 hospital admissions for 393 children with antibody-associated vasculitis (AAV) treated during an 11-year period. All patients had a charge for glucocorticoid medications and billing data were used to document receipt of treatment. The researchers used mixed-effects logistic regression to assess factors linked to the likelihood of receiving each of the three glucocorticoid treatment regimens (cyclophosphamide, rituximab or both).
patients, 16% required dialysis and 17% required mechanical ventilation. Median hospital length of stay was 9 days. Overall, 57% of children received cyclophosphamide; 21% received rituximab; and 10% received both treatments. Plasma exchange was administered to 22% of the children. An association was seen between mechanical ventilation and receipt of cyclophosphamide and plasma exchange. This link was not seen with rituximab. Investigators found an increasing trend in the use of rituximab during the study period, while a decreasing trend was seen in the use of cyclophosphamide. Significant disparity was seen in the treatments used between hospitals, particularly in terms of plasma exchange.
“Our results show that children with AAV are ill at presentation, more than one-quarter require ventilator or dialysis support, morbidity is high and readmissions are common,” the researchers wrote. “There is a vital need for pediatric-specific studies to evaluate the effectiveness and efficacy of cyclophosphamide, rituximab and plasma exchange in this population.” - by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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