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Rituximab tops azathioprine for relapsing ANCA-associated vasculitis remission maintenance

Key clinical point: Rituximab (Rituxan) is superior to azathioprine (Imuran) for preventing ANCA-associated vasculitis relapses in patients with histories of previous relapses.

Major finding: Eleven rituximab patients (13%) relapsed during the 20-month maintenance phase; two relapses were major. There were 32 relapses (38%) in the azathioprine group, 12 of them (38%) major (hazard ratio for rituximab versus azathioprine, 0.3; 95% CI, 0.15-0.60; P less than .001).

Study details: Open-label trial of 170 patients with either relapsing granulomatosis with polyangiitis or microscopic polyangiitis who were randomized after rituximab remission induction to maintenance therapy rituximab 1 g every 4 months for 20 months plus glucocorticoids or azathioprine 2 mg/kg per day plus glucocorticoids for 20 months, followed by a taper.

Disclosures: The work was funded by Versus Arthritis (formerly Arthritis Research UK), the National Institutes of Health, and the makers of rituximab, Roche/Genentech. Dr. Smith reported ties to Roche, Sanofi, and MedImmune.


Smith R et al. Arthritis Rheumatol. 2019;71(suppl 10), Abstract 806.