Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis

Rona M. Smith, Rachel Bronwen Jones, Ulrich Specks, Simon Bond, Marianna Nodale, Reem Aljayyousi, Jacqueline Andrews, Annette Bruchfeld, Brian Camilleri, Simon Carette, Chee Kay Cheung, Vimal Derebail, Tim Doulton, Lindsy Forbess, Shouichi Fujimoto, Shunsuke Furuta, Ora Gewurz-Singer, Lorraine Harper, Toshiko Ito-Ihara, Nader KhalidiRainer Klocke, Curry Koening, Yoshinori Komagata, Carol Langford, Peter Lanyon, Raashid Ahmed Luqmani, Hirofumi Makino, Carole McAlear, Paul Monach, Larry W. Moreland, Kim Mynard, Patrick Nachman, Christian Pagnoux, Fiona Pearce, Chen Au Peh, Charles Pusey, Dwarakanathan Ranganathan, Rennie L. Rhee, Robert Spiera, Antoine G. Sreih, Vladimir Tesar, Giles Walters, Michael H. Weisman, Caroline Wroe, Peter Merkel, David Jayne

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives Evaluation of rituximab and glucocorticoids as therapy to induce remission after relapse in ANCA-associated vasculitis (AAV) in a prospective observational cohort of patients enrolled into the induction phase of the RITAZAREM trial. Methods Patients relapsing with granulomatosis with polyangiitis or microscopic polyangiitis were prospectively enrolled and received remission-induction therapy with rituximab (4×375 mg/m 2) and a higher or lower dose glucocorticoid regimen, depending on physician choice: reducing from either 1 mg/kg/day or 0.5 mg/kg/day to 10 mg/day by 4 months. Patients in this cohort achieving remission were subsequently randomised to receive one of two regimens to prevent relapse. Results 188 patients were studied: 95/188 (51%) men, median age 59 years (range 19-89), prior disease duration 5.0 years (range 0.4-34.5). 149/188 (79%) had previously received cyclophosphamide and 67/188 (36%) rituximab. 119/188 (63%) of relapses had at least one major disease activity item, and 54/188 (29%) received the higher dose glucocorticoid regimen. 171/188 (90%) patients achieved remission by 4 months. Only six patients (3.2% of the study population) did not achieve disease control at month 4. Four patients died in the induction phase due to pneumonia (2), cerebrovascular accident (1), and active vasculitis (1). 41 severe adverse events occurred in 27 patients, including 13 severe infections. Conclusions This large prospective cohort of patients with relapsing AAV treated with rituximab in conjunction with glucocorticoids demonstrated a high level of efficacy for the reinduction of remission in patients with AAV who have relapsed, with a similar safety profile to previous studies.

Original languageEnglish (US)
Pages (from-to)1243-1249
Number of pages7
JournalAnnals of the rheumatic diseases
Issue number9
StatePublished - Sep 1 2020


  • B cells
  • granulomatosis with polyangiitis
  • systemic vasculitis
  • treatment

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • General Biochemistry, Genetics and Molecular Biology


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