The paradoxical reaction to rituximab in six granulomatosis with polyangiitis patients: How could it be explained and managed?

BACKGROUND Granulomatosis with polyangiitis is a systemic anti-neutrophil cytoplasmic antibody-associated vasculitides (AAVs), mainly involving the respiratory tract and renal system. Treatment by Rituximab as a next-generation therapy in ANCA-associated vasculitis was associated with promising outcomes in GPA patients. Despite symptoms improvements, disease recurrence and drug reaction was a challenging topic nowadays. OBJECTIVES In this study, we examined six GPA patients who were confirmed to have paradoxical reactions to rituximab and then described How to control their symptoms. METHODS In this study, all the systemic GPA patients (diagnosed based on ACR/EULAR criteria) who received RTX in Amir-Allam hospital, were monitored for any sign of disease exacerbation up to 3 months after RTX exposure. RESULTS From 78 GPA-diagnosed patients, six, including one man and five women with the mean age of 37.3 ± 13.8, were identified for exacerbation after RTX administration. CONCLUSION According to our observation, it could be recommended that not to deprive the patient of the benefits of RTX treatment due to the early patient's possible complications.