Scientists comment on two clinical trials that use Rituximab to treat small-vessel vasculitis

UNC School of MedicineJul 15 2010

Two UNC School of Medicine faculty authored an editorial in the July 15, 2010 New England Journal of Medicine commenting on results from two clinical trials using the drug Rituximab to treat small-vessel vasculitis, a rare autoimmune disease.

The trials took place in the United States - Rituximab in ANCA-Associated Vasculitis (RAVE) -- and in Europe -- Rituximab versus cyclophosphamide in ANCA-Associated renal vasculitis (RITUXIVAS). Both trials showed that rituximab was effective in inducing a remission, compared with intravenous cytoxan, used in the RITUXIVAS trial, or oral cyclophosphamide, used in the RAVE trial.

Rituximab is used to treat non-Hodgkins lymphoma by targeting a specific protein on the surface of B lymphocytes, a type of immune cell. A different B-cell protein is the target of vasculitis.

Ronald J. Falk, MD, professor of medicine and director of the UNC Kidney Center, and Charles Jennette, MD, professor and chair of the department of pathology and laboratory medicine, are international experts in vasculitis and co-authors of the editorial. In 1988, Falk and Jennette characterized one of the markers for vasculitis found in blood serum, and Falk leads the UNC vasculitis program.

In their Editorial, Falk and Jennette note, "The practical implications of these two studies are substantial. Rituximab might be considered as an option for first-line therapy for induction of remission of ANCA-associated disease. They conclude, "For now, these trials lend hope for our patients that targeted therapy may quell this B-cell driven autoimmune disease."

Vasculitis develops when blood vessels become inflamed, causing damage to tissue and organs. At present, the causes of vasculitis are unknown. A bold marker for the disease found, called ANCA -- antineutrophil cytoplasmic autoantibody -- has a role in the development of the illness by activating specific white blood cells, resulting in damage to the blood vessels.

All of more than 15 types of vasculitis are classified as rare diseases. In the U.S., a rare disease -- also called an orphan disease -- is a disease or condition affecting fewer than 200,000 persons.

Falk serves as a medical consultant for the Vasculitis Foundation, the international group for patients and families. "Rituximab provides another important therapeutic tool that may improve the lives of some patients with vasculitis," he said.