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Rituximab in ANCA-associated vasculitis: fewer infusions or ultra low-dose maintenance therapy?
  1. Sergey V Moiseev1,
  2. Nikolai M Bulanov1,
  3. Anastasiia S Zykova2,
  4. Pavel I Novikov1
  1. 1 Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
  2. 2 Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russian Federation
  1. Correspondence to Professor Sergey V Moiseev, Sechenov First Moscow State Medical University, Tareev Clinic of Internal Diseases, Moscow, 119435, Russian Federation; clinpharm{at}

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a life-threatening disease characterised by a recurrent course and progressive accumulation of irreversible damage of vital organs, that is, kidney and lungs. Before the advent of immunosuppression, AAV was usually fatal, that is, up to 80%–90% of patients were expected to die within 1 to 2 years after diagnosis. Aggressive immunosuppressive treatment with cyclophosphamide and high-dose corticosteroids has improved the outcomes in patients with AAV at the cost of significant toxicity.1 Not surprisingly, the researchers are focused on exploring the new regimens of immunosuppression that can provide a similar efficacy with an improved safety. These attempts were at least partly successful particularly due to the introduction of rituximab both for remission induction and maintenance treatment. Moreover, current evidence suggests that a proportion of patients with AAV are overtreated with rituximab and may benefit from an optimised maintenance therapy.

In the recently published multicentre, randomised controlled, phase III trial (MAINRITSAN2), the investigators from the French Vasculitis Study Group compared the efficacy and safety of a tailored rituximab regimen, based on monitoring of ANCA titre and CD19+ B-cell counts, with fixed-schedule rituximab infusions in 162 patients with granulomatosis with polyangiitis or microscopic polyangiitis, who were in complete remission at the time of enrolment.2 Patients from the first group were scheduled to receive 500 mg of rituximab at randomisation, while rituximab infusions were repeated only when serial monitoring showed an increase in ANCA titre …

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  • Contributors All authors participated in the preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.