[Review of the current use of rituximab during 4 years in a French university hospital]. / Le rituximab dans la vraie vie: revue d'utilisation du rituximab de 2010 à 2013 au CHU de Saint-Étienne.

PURPOSE: Rituximab is a human/murine chimeric monoclonal antibody primarily used for treating non-Hodgkin's B-cell lymphoma. Recently, it has also been used in the treatment of several autoimmune diseases. PATIENTS AND METHODS: We conducted a retrospective analysis of patients treated at least once with rituximab between 2010 and 2013 in a French university hospital, to provide a panoramic view of rituximab use including FDA or off-labels uses, its efficacy and safety. RESULTS: Eighty-seven patients were included with 20 different indications: cryoglobulinemic vasculitis (16%) and anti-PLA2R idiopathic membranous nephropathy (13%) were the most frequent. Rituximab use was off-labels in 50% of cases. Eleven percent of patients experienced severe adverse events, mostly infections. After rituximab, 17% of patients were in complete response (CR), 41% in partial response (PR), and 39% non-responding (NR). Relapse was observed in 65% (33/51) of responding patients. CONCLUSION: Further investigation with randomized controlled trials will provide more insight into the specifics of the role of RTX in the overall management of each disease. Identifying clear objectives and strict outcome measures, associated with long term clinical and biological follow-up would help deciding when, how and in which therapeutic regimen will rituximab most benefit a disease or a patient.

Association of Anti-glycan Antibodies and Inflammatory Bowel Disease Course.

BACKGROUND AND AIMS: The usefulness of anti-glycan antibodies alone or combined with anti-Saccharomyces cerevisiae [ASCA] or perinuclear antineutrophil cytoplasmic [pANCA] antibodies for diagnosis of inflammatory bowel disease [IBD], differentiation between Crohn's disease [CD] and ulcerative colitis [UC], disease stratification including IBD phenotype, and also for determination of the course of the disease, remain unclear. METHODS: A large panel of serological anti-glycan carbohydrate antibodies, including anti-mannobioside IgG antibodies [AMCA], anti-chitobioside IgA [ACCA], anti-laminaribioside IgG antibodies [ALCA], anti-laminarin [anti-L] and anti-chitine [anti-C] were measured in the serum from a cohort of 195 patients with IBD] [107 CD and 88 UC]. The respective accuracy of isolated or combined markers for diagnosis, disease differentiation, stratification disease phenotype, and severity of the disease course, defined by a wide panel of criteria obtained from the past medical history, was assessed. RESULTS: The positivity of at least one anti-glycan antibody was detected in a significant higher proportion of CD and UC compared with healthy controls [p < 0.0001 and p < 0.0007, respectively]. Whereas ASCA and ANCA antibody status had the highest efficacy to be associated with CD in comparison with UC (area under receiver operating characteristic curve [AUROC] = 0.70 for each], the adjunction of anti-laminarin antibody substantially improved the differentiation between CD and UC [AUROC = 0.77]. Titres of ACCA [> 51U/ml] and anti-laminarin [> 31U/ml] were significantly linked with a higher association with steroid dependency (odds ratio [OR] =2.0 [1.0-4.0], p = 0.03 and OR = 2.4 [1.1-5.2], p = 0.02, respectively]. We further defined the respective performance of anti-glycan antibodies to discriminate between patients with severe or not severe CD and UC course and determined the associated optimal cut-off values: severe CD course was significantly more likely in case of AMCA > 77U/ml [OR = 4.3; p = 0.002], ASCA > 63U/ml [OR = 3.5; p < 0.009] and at a lesser degree ACCA > 50U/ml [OR = 2.8; p < 0.02] and severe UC course was significantly associated with AMCA > 52U/ml [OR = 3.4; p = 0.04] and ACCA > 25U/ml [OR = 3.0; p < 0.04]. CONCLUSIONS: Anti-glycan antibodies are valuable serological markers, especially AMCA antibodies that may help clinicians to promptly classify patients into high risk for severe disease.