Maintenance Treatment and the Risk of Serious Infections in AAV

Researchers found maintenance therapy with rituximab among people with ANCA-associated vasculitis (AAV) to be generally safe after finding no increase in incidence of serious infections post-therapy, according to results of the systematic review published in Frontiers in Medicine.

Infectious complications are some of the most common adverse outcomes in patients with AAV, the investigators said. According to a recent meta-analysis, the incidence of serious infections in rituximab-treated patients during induction period was 15.40%. However, not much is known about the risk of serious infections during the maintenance period.

The investigators identified 21 studies from PubMed and EMBASE for randomized clinical trials and observational studies to include data from a total of 2,938 patients with AAV. Of these, 48.1% of the patients were treated with rituximab, 32.1% with azathioprine, 16.0% with methotrexate, and 3.8% with mycophenolate mofetil.

“We found that the cumulative incidence of serious infections was 7.62% during the maintenance period,” the report read. More than half (53%) of the serious infections reported were pneumonia, or other infections of the upper respiratory tract.

The death rate from serious infections was 0.49%. Of the patients treated with rituximab, 1.29% died as a result of the infection; of the patients treated with azathioprine, 0.3% died.

“Overall, we found an infection-related mortality during the maintenance period lower than 1%,” the researchers concluded. In addition to being an effective therapy, rituximab also did not increase the incidence of serious infections among patients with AAV, they added.

—Priyam Vora

Reference:
Vassilopoulos A, Vassilopoulo0s S, Kalligeros M, Shehadeh F and Mylonakis E. Incidence of serious infections in patients with ANCA-associated vasculitis receiving immunosuppressive therapy: A systematic review and meta-analysis. Frontiers in Medicine. 2023: 10. DOI: https://doi.org/10.3389/fmed.2023.1110548