Important new studies, from New England Journal of Medicine

[Palmyra]

All of our Weg hero docs have finally gotten a significant paper reported in the New England Journal of Medicine regarding a multi-centered trial comparison of Cytoxin vs Rituxin in obtaining disease remission in ANCA associated vascultis. You will be familiar with all the authour names....its like an all star game!


Rituximab and Cyclophosphamide: A Tale of Two Treatments | Now@NEJM

This is the first published study on a new med to treat Weg in 40 years. Big news. Will hope it will also bring attention to the medical community at large, about this disease, and the growing numbers of those affected by Autoimmune Disease in general.

[Sangye]

Thanks for posting that-- very exciting to get Wegs research into NEJM.

The editorial link in the article had my favorite line, "For now, RITUXIVAS and RAVE lend hope for our patients that targeted therapy may quell this B-cell–driven autoimmune disease."

May it be so.

[drz]

Rituximab seemed to have more side effects but slight better remission rate. Death rate was same for both of 18%. Like one of my colleagues said to me "if you survive the treatment, it will get better.

I wonder when Mayo at Rochester will publish their results of treatment with Rituximab.

[pberggren1]

Is this Rituxivas and Rave the same as Rituximab and Rituxan?

[Sangye]

RITUXIVAS and RAVE were the names of the 2 trials discussed in the article.

The cool thing is that since the RAVE study (the more recent of the two), the Wegs docs are using it more and much more data is coming in.

Dr Seo said that for straight kidney involvement, rtx has no advantage over ctx for inducing remission. (He also said involvement isolated to the kidneys was "easy" to get under control-- the easiest of all)

But for relapsing Wegs and refractory (non-responsive), rtx is significantly better than ctx. My refractory Wegs sure wasn't willing to negotiate with any drug but rtx.

[Palmyra]

Confusing, but would love to hear more thoughts on this subject......

As per my understanding:

There were two studies published in this most recent New England Journal of Medicine, both comparing the use of cytoxin vs Rituxin for the treatment of ANCA related vascultis. One was conducted in England, titled "Rtuxivas" and the other was a muti-centered trial entitled "RAVE". The RAVE trial's lead clinician was Ulrich Specks,MD of the Mayo Clinic. The author was Stone, MD of Boston, MA. The "RAVE" trials were conducted at multiple hospital sites throughout the USA, including the Mayo Clinic, Rochester.

My daughter just recently saw Dr Specks for treatment....his opinion seems to be similar to Dr Seo as Sangye related previously, that Rituxin may have less morbidity/side effects than cytoxin when used to treat refractory disease. Important to note that cytoxin in this particular study was 'oral', and may therefore have a higher incidence of toxicity. Yet to be addressed is what long term effects of Rituxin therapy may be, and if a sustained remission is possible with this treatment.

[drz]

RITUXIVAS and RAVE were the names of the 2 trials discussed in the article.

The cool thing is that since the RAVE study (the more recent of the two), the Wegs docs are using it more and much more data is coming in.

Dr Seo said that for straight kidney involvement, rtx has no advantage over ctx for inducing remission. (He also said involvement isolated to the kidneys was "easy" to get under control-- the easiest of all)

But for relapsing Wegs and refractory (non-responsive), rtx is significantly better than ctx. My refractory Wegs sure wasn't willing to negotiate with any drug but rtx.

The doctors tried me first on Rituxan but it wasn't working fast enough. Their impression from the work at Mayo in Rochester was that it might have less side effects but the the study above doesn't support that view. The doctors on my teams at the U of M Medical Center said they could try Rituxan first and if it didn't work go to Cytoxan which is what they did. The doctors said they could not do the reverse though.

[Palmyra]

I can understand how serious, acute disease may not respond rapidly enough for Rituxin treatment. Cytoxin and plasmapherisis still has a place for severe/acute disease. What is to be said for long term maintenance and medically induced remission? I think those are for a later major study, yet to be determined. Much to learn.

My daughter was fortunate in disease diagnosis/control to use Rituxin as a primary response after 5+ months of poor response to pred/methotrx treatment and an early diagnosis.....holding the really bad symptoms at bay, until U. Specks,MD suggested Rituxin as a primary treatment tool.

It has worked for her and has so far (for four years!) and she has had no serious side effects exception of immunosuppression and related opportunistic infection.

Thanks for your input, as this is a great msg board. Really pleased with the group :-)

Palmyra-Jane, hoping to climb Long's Peak in mid-August...but buying trip insurance none the less!

[Palmyra]

The cool thing is that since the RAVE study (the more recent of the two), the Wegs docs are using it more and much more data is coming in.

[Sangye]

The doctors on my teams at the U of M Medical Center said they could try Rituxan first and if it didn't work go to Cytoxan which is what they did. The doctors said they could not do the reverse though.

Since rtx destroys all the B cells for 6-12 months, you couldn't jump onto ctx until you had some B cell recovery. For most people in need of a big drug, that lag time is way too long.

I think as they get more data on long-term rtx use they'll be better able to compare side effects. The RAVE study only followed people for 6 months. If I'm interpreting this correctly, that would only allow them to compare the initial 6 months of side effects for each drug. Many of ctx's worst side effects and damage come later on.