Long-Term Rituximab Gets the Job Done in Vasculitis

Guillevin L, Pagnoux C, Karras A, et al. for the French Vasculitis Study Group. Rituximab versus Azathioprine for Maintenance in ANCA-Associated Vasculitis. New England Journal of Medicine (2014) 371:1771-1780 doi:10.1056/NEJMoa1404231. Online Nov. 6

Jayne D. Editorial: Extending the Indications for Rituximab in ANCA-Associated Vasculitis.New England Journal of Medicine (2014) 371:1839-1840 doi:10.1056/NEJMe1410394. Online Nov. 6

Rituximab proves superior to azathioprine for maintaining remission in antineutrophil cytoplasm antibody (ANCA)-associated vasculitis, according to new trial results.

The rate of major relapse at month 28 came in at 5% for rituximab (500 mg every 6 months) and 29% for azathioprine, for a hazard ratio of 6.6.

The “real value” of these findings is that a patient has a low risk of relapse with rituximab maintenance, according to an accompanying editorial. Also, immunosuppressive agents and glucocorticoids may not be necessary, and the rituximab-based regimen offers a better opportunity for recovery and rehabilitation.

For this trial, 115 patients with newly diagnosed or relapsing granulomatosis with polyangiitis (GPA), microscopic polyangiitis, or renal-limited ANCA-associated vasculitis were in complete remission after treatment with cyclophosphamide and glucocorticoids.

They were randomized to rituximab or azathioprine. Both drugs had an equivalent frequency of severe adverse events. Whether a lower rituximab dose will be equally effective remains to be established.