Long-term follow-up of relapsing/refractory anti-neutrophil cytoplasm antibody associated vasculitis treated with the lymphocyte depleting antibody alemtuzumab (CAMPATH-1H)
Abstract
Objective Lymphocytes are a contributor to the pathogenesis of anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AASV). Conventional immunosuppressive therapy is associated with high rates of relapse and toxicity. Humanised monoclonal anti-CD52 antibodies (alemtuzumab, CAMPATH-1H) selectively deplete lymphocytes. We present long-term follow-up results of patients with relapsing/refractory AASV treated with CAMPATH-1H.Patients and methods Between 1991 and 1999, 71 patients with refractory or relapsing AASV received CAMPATH-1H at Addenbrooke's Hospital, Cambridge, UK. Other immunosuppressive drugs were discontinued and prednisolone was tapered to 10 mg/day.Results The mean follow-up time was 5 years. In all, 79% had previously received cyclophosphamide (median dose 150 g). At the time of treatment, 42% had renal involvement (median creatinine for the cohort 101 micromol/litre excluding six patients who were dialysis dependent) and 18% were critically ill from AASV and required the intensive care unit. A total of 60 patients (85%) obtained a remission after treatment with CAMPATH-1H but 43 relapsed (median 9.2 months); 24 had a remission greater than 1 year, of which 10 had a remission of at least 3 years. A total of 31 patients died (median survival time of 106 months). Age >50 years, dialysis dependency and the development of a severe infection at the time of treatment were associated with an increased risk of death in multivariable analysis. Adverse events were common; 28 patients developed an infection, 3 malignancy and 8 thyroid disease.Conclusions CAMPATH-1H induced remission in most patients with difficult to treat AASV. However, relapse and adverse events were common. Further study of CAMPATH-1H as an induction agent in AASV is warranted.
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The value of baseline antithyroid antibody levels before alemtuzumab treatment for indications other than MS has not been studied.
“The value of baseline antithyroid antibody levels before alemtuzumab treatment for indications other than MS has not been studied [30].”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [30]
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- Authors
- Walsh, M., Chaudhry, A., & Jayne, D.
- Affiliations
- Addenbrooke's Hospital (GB)
- Corresponding author
- Walsh, M
- ORCID
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 67
- Issue
- 9
- Pages
- 1322-1327
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W2143800846
- Cited by
- 178
- References
- 19
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 7 · 2018: 8 · 2017: 8 · 2016: 5 · 2015: 13 · 2014: 18 · 2013: 21 · 2012: 13
- FWCI
- 10.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vasculitis and related conditions
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Keywords
- ANCA-associated vasculitis, alemtuzumab, Campath-1H, lymphocyte depletion, remission, long-term follow-up, mortality, infection risk, cyclophosphamide, renal involvement, adverse events, induction therapy
- MeSH terms
- Alemtuzumab, Adult, Antibodies, Monoclonal, Antibodies, Neoplasm, Autoimmune Diseases, Epidemiologic Methods, Female, Humans, Lymphocyte Depletion, Male, Middle Aged, Recurrence, Vasculitis, Treatment Outcome, CD4 Lymphocyte Count, Antibodies, Antineutrophil Cytoplasmic, Antibodies, Monoclonal, Humanized
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