Anti-tumour necrosis factor treatment in patients with refractory systemic vasculitis associated with rheumatoid arthritis

• DOI: 10.1136/ard.2007.081679
• Publication Date: 2007-11-24T01:33:49Z
• Authors: X Puéchal; C Miceli-Richard; O Mejjad; P Lafforgue; C Marcelli; E Solau-Gervais; S Steinfeld; C Villoutreix; R Trèves; X Mariette; L Guillevin
• Keywords: Adult; Male; Allergie et immunopathologie; Receptors, Tumor Necrosis Factor; Etanercept; Arthritis, Rheumatoid; 03 medical and health sciences; 0302 clinical medicine; Recurrence; Immunologie; Humans; Cyclophosphamide; Adjuvants, Pharmaceutic; Aged; Remission Induction; Antibodies, Monoclonal; Middle Aged; Infliximab; 3. Good health; Rhumatologie; Antirheumatic Agents; Immunoglobulin G; Prednisone; Female; Biologie; Immunosuppressive Agents; Follow-Up Studies

To assess anti-tumour necrosis factor (anti-TNF) agents in patients with refractory systemic rheumatoid vasculitis (SRV).1200 rheumatologists and internists were asked to provide medical files for patients with anti-TNF agents given as a second-line treatment for active SRV refractory to cyclophosphamide and glucocorticoids.We identified nine cases in which anti-TNF drugs were given for active SRV, despite previous treatment with a mean cumulative dose of 8.4 g of cyclophosphamide in association with high-dose glucocorticoids. The mean prednisone dose before anti-TNF therapy was 29.6 mg/day. After 6 months, six patients were in remission (complete in five, partial in one). The treatment failed in one patient and two patients stopped taking the anti-TNF treatment due to side-effects. Mean prednisone dose was reduced to 11.2 mg/day. Severe infection occurred in three patients. Relapses were observed in two patients. Remission was re-established by reintroducing anti-TNF therapy in one case and increasing the dose in the other.This study provides evidence of efficacy of anti-TNF therapy in adjunct to glucocorticoids for treating active refractory SRV. Remission was achieved in two-thirds of patients, with a significant decrease in prednisone dose, although there was a high rate of infection in these severely ill patients.