Work

Reduced-dose obinutuzumab induces remission in refractory ANCA-associated vasculitis: a report of 16 cases

Year: 2025

Type: article

Abstract: Objective: Rituximab remains the standard-of-care anti-CD20 therapy for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Obinutuzumab, a next-generation, glycoengineered anti-CD20 monoclonal antibody with enhanced B-cell-depleting capacity, may offer superior efficacy. We evaluated the efficacy and safety of reduced-dose obinutuzumab in 16 patients with active, refractory AAV at a single center in China. Methods: In this retrospective chart review, we evaluated 16 consecutive patients who received reduced-dose obinutuzumab (most commonly 1,000 mg for induction) after failure to achieve remission with cyclophosphamide (CTX) and/or rituximab (RTX) or who presented with severe, treatment-naïve disease. Primary endpoints were complete remission (CR) rates at 24 and 76 weeks. Secondary endpoints included changes in renal function, inflammatory biomarkers, and immune reconstitution. Adverse events were prospectively recorded. Results: The median age at obinutuzumab initiation was 44.5 years (IQR 31-54.3); 10 (62.5%) were men. The mean Birmingham Vasculitis Activity Score (BVAS) was 13.5 ± 6.4. There were 12 patients (75%) who had relapsing disease refractory to CTX/RTX, whereas four treatment-naïve patients presented with multiorgan failure. CR was achieved in 8/16 patients (50%) at week 24 and 13/16 patients (81.3%) at week 76. Obinutuzumab induced rapid clinical remission, suppressed systemic inflammation, achieved peripheral B-cell depletion, rendered ANCA-negative, and improved renal and pulmonary outcomes. No severe infections occurred. Seven patients (43.8%) developed treatment-emergent infections, predominantly respiratory (75%). Conclusion: Reduced-dose obinutuzumab demonstrates sustained remission in refractory or relapsing active AAV, achieving high long-term remission rates with an acceptable safety profile. No severe invasive infections were observed.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2025.1624234

Authors: Wenyi Wu, Juan Wang, Sheng Chen

Institutions: Shanghai Jiao Tong University, Renji Hospital

Language: English

Topic: Vasculitis and related conditions

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801