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Daratumumab for the treatment of refractory ANCA-associated vasculitis

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Item Type:Article
Title:Daratumumab for the treatment of refractory ANCA-associated vasculitis
Creators Name:Ostendorf, L. and Burns, M. and Wagner, D.L. and Enghard, P. and Amann, K. and Mei, H. and Eckardt, K.U. and Seelow, E. and Schreiber, A.
Abstract:OBJECTIVE: Treatment-refractory antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a life-threatening condition without evidence-based treatment options. One emerging treatment option for several antibody-mediated autoimmune diseases is the anti-CD38 antibody daratumumab, which depletes autoantibody-secreting plasma cells. METHODS: We treated two patients with severe life-threatening AAV with renal and pulmonary manifestation despite induction therapy with rituximab and cyclophosphamide with four to eight doses of 1800 mg daratumumab. We followed clinical and immunological responses. RESULTS: The first patient with myeloperoxidase-ANCA-positive microscopic polyangiitis had resolution of pneumonitis and pleuritis and stabilisation of kidney function after daratumumab. The second patient with proteinase 3-ANCA-positive granulomatosis with polyangiitis, diffuse alveolar haemorrhage necessitating extracorporeal membrane oxygenation (ECMO) and acute kidney failure, requiring kidney replacement therapy, was weaned off ECMO, mechanical ventilation and dialysis and discharged home after daratumumab. Clinical improvement was paralleled by a strong reduction in serum ANCA levels as well as total IgG, indicating depletion of plasma cells. Apart from the depletion of CD38(+) natural killer cells, blood leucocyte levels were not notably influenced by daratumumab. Only mild adverse events, such as hypogammaglobulinaemia and an upper respiratory tract infection occurred. CONCLUSION: Daratumumab was safe and effective in inducing remission in two patients with severe treatment-refractory AAV, warranting prospective clinical trials to establish safety and efficacy.
Keywords:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Antineutrophil Cytoplasmic Antibodies, Monoclonal Antibodies, Prospective Studies
Source:RMD Open
Publisher:BMJ Publishing Group
Page Range:e002742
Date:10 January 2023
Official Publication:https://doi.org/10.1136/rmdopen-2022-002742
PubMed:View item in PubMed

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