TY - JOUR T1 - Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis DO - 10.1136/annrheumdis-2017-212768 SP - annrheumdis-2017-212768 AU - Benjamin Terrier AU - Christian Pagnoux AU - Élodie Perrodeau AU - Adexandre Karras AU - Chahera Khouatra AU - Olivier Aumaître AU - Pascal Cohen AU - Olivier Decaux AU - Hélène Desmurs-Clavel AU - François Maurier AU - Pierre Gobert AU - Thomas Quémeneur AU - Claire Blanchard-Delaunay AU - Bernard Bonnotte AU - Pierre-Louis Carron AU - Eric Daugas AU - Marize Ducret AU - Pascal Godmer AU - Mohamed Hamidou AU - Olivier Lidove AU - Nicolas Limal AU - Xavier Puéchal AU - Luc Mouthon AU - Philippe Ravaud AU - Loïc Guillevin A2 - , Y1 - 2018/05/03 UR - http://ard.bmj.com/content/early/2018/05/03/annrheumdis-2017-212768.abstract N2 - Objective To compare long-term efficacy of remission-maintenance regimens in patients with newly diagnosed or relapsing antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides.Methods The 28-month Maintenance of Remission using Rituximab in Systemic ANCA-associated Vasculitis trial compared rituximab with azathioprine to maintain remission in patients with newly diagnosed or relapsing granulomatosis with polyangiitis, microscopic polyangiitis or renal-limited ANCA-associated vasculitis. Thereafter, prospective patient follow-up lasted until month 60. The primary endpoint was the major-relapse rate at month 60. Relapse and serious adverse event-free survival were also assessed.Results Among the 115 enrolled patients, only one was lost to follow-up at month 60. For the azathioprine and rituximab groups, respectively, at month 60, the major relapse-free survival rates were 49.4% (95% CI 38.0% to 64.3%) and 71.9% (95% CI 61.2% to 84.6%) (p=0.003); minor and major relapse-free survival rates were 37.2% (95% CI 26.5% to 52.2%) and 57.9% (95% CI 46.4% to 72.2%) (p=0.012); overall survival rates were 93.0% (95% CI 86.7% to 99.9%) and 100% (p=0.045) and cumulative glucocorticoid use was comparable. Quality-adjusted time without symptoms and toxicity analysis showed that rituximab-treated patients had 12.6 months more without relapse or toxicity than those given azathioprine (p<0.001). Antiproteinase-3-ANCA positivity and azathioprine arm were independently associated with higher risk of relapse. HRs of positive ANCA to predict relapse increased over time.Conclusion The rate of sustained remission for ANCA-associated vasculitis patients, following rituximab-based or azathioprine-based maintenance regimens, remained superior over 60 months with rituximab, with better overall survival.Trial registration number NCT00748644. ER -