Thread by @JesusLoarce

RITAZAREM ➡️ Rituximab (RTX) versus azathioprine (AZA) for maintenance of remission for patients with ANCA-associated vasculitis (ANCA-AV) and relapsing disease.

👀Thread👀

#vasculitis #rituximab #MedEd

ard.bmj.com/content/early/…

Design:
- Open label, randomized.
- Patients with relapsing GPA or MPA, ANCA +.
- Induction phase (4 months): RTX 375 mg/m2x4 doses.
- Maintenance phase (4-24 months). Randomized to RTX (1 gram every 4 months, 5 doses) vs AZA (2 mg/kg).
- Follow-up phase (12-24 months).

Results:
- 170 patients randomized.
- 72% anti-PR3 and 28% anti-MPO. 62% severe relapse on entry into trial.
- Glucocorticoid (GC) induction: 28% 1 mg/kg/day and 72% 0.5 mg/kg/day.
- 78% prior treatment with cyclophosphamide!

- ⬆️relapse in AZA group during combined maintenance and follow-up phase (HR 0.41, 95% CI 0.27 to 0.61, p<0.001). ⬆️relapse in each phase
- ⬆️major and⬆️minor relapse in AZA.
- At month 24, 29% patients in RTX and 46% in AZA were still receiving GC (men dose 2.28 vs 2.8 mg).

- No differences in damage or quality of life.
- Severe AEs ➡️22% RTX vs 36% AZA group.
- Plasma IgG level <5g/L ➡️42% RTX vs 31% AZA (note: all groups induced with RTX).
- Predictors of ⬇️Ig: ⬆️GC induction regimen and ⬇️baseline plasma IgG.

In conclusion, RTX was superior to AZA for maintenance in patients with relapsing ANCA-AV.

SAEs and infections were common, consistent with previous studies. Hypogammaglobulinemia was common in both groups (both induced with RTX).

Check EULAR recommendations for the management of
ANCA-AV: 2022 update➡️Induction and maintenance with RTX in GPA and MPA.

ard.bmj.com/content/early/…