Risk Factors for Relapse in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis Among Patients With Relapse After Induction of Remission With Rituximab
Year: 2025
Type: article
Abstract: Objective The objective of the study was to determine risk factors for relapse of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) after reinduction of remission with rituximab and discontinuation of maintenance therapy. Methods This is a post hoc analysis of the RITAZAREM clinical trial. Patients aged 15 years or older with AAV and a positive test for anti–proteinase‐3 or anti‐myeloperoxidase‐ANCA who achieved remission after reinduction with rituximab and glucocorticoids were randomized at month 4 to receive continued rituximab or azathioprine for a maintenance period up to 24 months, followed by observation until relapse or up to 48 months. Generalized estimating equations logistic regression identified baseline and time‐varying risk factors for relapse by the next visit for the two study phases: maintenance (months 4–24) and off‐treatment (months 24–48). Results Among 170 patients (median [interquartile range] age 59 [48–68] years, disease duration 5 [2–10] years), 99 relapses occurred (46 during maintenance). During maintenance, musculoskeletal involvement (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.1–7.2; P = 0.03) and higher patient global assessment (OR: 1.1, 95% CI: 1.0–1.2; P = 0.04) were associated with relapse. During the off‐treatment phase, presence of CD19 + B cells (OR: 2.5, 95% CI: 1.2–5.1; P = 0.01) and reappearance of ANCA (OR: 3.2, 95% CI: 1.3–7.7; P = 0.01) were each associated with higher relapse risk. Multivariable analysis identified markers of inflammation (changes in platelets, white blood cells, and IgA) associated with relapse. Conclusion Risk factors for relapse in AAV vary by treatment phase. Monitoring markers of inflammation and immune reconstitution may identify patients at risk for relapse, particularly after treatment withdrawal.
Source: Arthritis & Rheumatology
DOI: 10.1002/art.70025
Authors: Ellen Romich, Joshua F. Baker, Thomas R. Riley, Ian Green, Rennie L. Rhee, Carol A. McAlear, Ulrich Specks, Rona M. Smith, David R. Jayne, Peter A. Merkel, for the RITAZAREM Investigators
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,190
Funders: Roche, University of Pennsylvania, Cleveland Clinic, Cleveland Clinic Foundation, Univerzita Karlova v Praze, Hospital for Special Surgery, ACT Government, National Institute for Health and Care Research, University of Cambridge, Imperial College London, University of Oxford, University of Nottingham, Cambridge University Hospitals, Ministry of Health, Labour and Welfare, University of Toronto, Royal Adelaide Hospital, Università degli Studi di Parma, Versus Arthritis, National Institutes of Health, Genentech, Rehabilitation Research and Development Service, University of North Carolina at Chapel Hill, Perelman School of Medicine, University of Pennsylvania, NIHR Cambridge Biomedical Research Centre, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences
OpenAlex ID: W4417479312