Work

Cyclophosphamide Plus Rituximab Versus Cyclophosphamide in Antineutrophil Cytoplasmic Antibody–associated Vasculitis With Kidney Involvement: A Retrospective Cohort Study in China

Year: 2025

Type: article

Abstract: Rationale & Objective Intravenous cyclophosphamide (CTX) or rituximab (RTX), combined with glucocorticoids are first-line therapies for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We aimed to compare the efficacy of CTX plus RTX and CTX alone, in combination with glucocorticoids for AAV patients with kidney injury. Study Design Retrospective cohort study. Setting & Participants 76 newly diagnosed AAV patients with kidney involvement, divided into glucocorticoids plus CTX group (control group, n=36) and glucocorticoids plus CTX and RTX group (combination group, n=40). Exposure CTX plus RTX or CTX alone, in combination with glucocorticoids. Outcomes Kidney failure, remission, death, combined events endpoint of kidney failure and/or death, relapse, and adverse events. Analytical Approach Unpaired t-test, Mann-Whitney U test, Pearson χ2 test or Fisher's exact test, and Kaplan–Meier method with log-rank test. Results The median follow-up period was 29.7 (20.4, 37.4) months. The remission rate was significantly higher in combination group than control group at 6 months (85.0% vs 52.8%, p=0.002). However, there were no significant differences in the remission rates at 12 months and final follow-up, as well as kidney failure, death, relapse, or improvement of renal function during follow-up between groups. The cumulative dose of glucocorticoids in combination group was 2.5 (2.0, 3.3) g at 6 months and 3.7 (2.6, 4.8) g at final follow-up, significantly lower than those in control group (p<0.001, p<0.001 respectively). In the subgroup of 45 patients with eGFR>15 ml/min/1.73m 2 at admission, 7 of 21 patients in control group and 1 of 24 patients in combination group progressed to kidney failure (33.3% vs 4.2%, p=0.02). Limitations Primarily Chinese, retrospective data. Conclusions The combination of glucocorticoids, CTX, and RTX is better in achieving early disease remission and reducing the dose of glucocorticoids for AAV patients.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2025.101169