Clinical scenarios of suboptimal response to rituximab in relapsing ANCA-associated vasculitis
Year: 2026
Type: article
Abstract: Background Rituximab is effective for induction and maintenance of remission in relapsing ANCA-associated vasculitis (AAV), but some patients do not achieve complete remission or experience relapse despite treatment. We aimed to describe the frequency, characteristics, and outcomes of patients with suboptimal response to rituximab within the RITAZAREM trial. Methods Post hoc descriptive analysis, including patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) treated with rituximab for induction ( N = 188) and those receiving rituximab maintenance ( N = 85). Three scenarios of suboptimal response were examined: (i) failure to achieve protocol-defined remission at month 4 ( n = 6); (ii) incomplete remission at month 4, defined as BVAS/WG = 1 ( n = 10); and (iii) relapse during rituximab maintenance ( n = 13). Data were summarized descriptively. Time to relapse from month 4 in patients with BVAS/WG = 1 versus BVAS/WG = 0 was explored using Kaplan–Meier analysis. Results Six of 188 patients (3%) did not achieve protocol-defined remission by month 4, 10 (5%) had residual low-grade disease activity (BVAS/WG = 1), and 13 of 85 patients (15%) receiving rituximab maintenance relapsed within 24 months during maintenance treatment. All patients with BVAS/WG = 1 at month 4 had a history of PR3-ANCA positivity and ear/nose/throat (ENT) baseline manifestations. Relapse occurred more frequently in this subgroup than in patients with BVAS/WG = 0, and time-to-relapse analysis showed shorter relapse-free survival, although interpretation is limited by the small sample size. Most first relapses were minor, and some patients subsequently experienced additional relapses, including major relapses. Conclusion In this exploratory and hypothesis-generating analysis, a small subset of patients with relapsing AAV showed suboptimal outcomes with rituximab. Residual disease activity at month 4, particularly in patients with PR3-ANCA positivity and ENT involvement, may represent a clinical subgroup associated with an increased frequency of earlier relapse, although this observation requires confirmation.
Source: Frontiers in Medicine
Authors: Sergio Prieto-González, Ellen Romich, Peter A. Merkel, David R. W. Jayne, Rona M. Smith, Giles Walters, Chen Au Peh, Dwarakanathan Ranganathan, Simon Carette, Nader Khalidi, Vladamir Tesar, Michael Clarkson, Augusto Vaglio, Shunsuke Furuta, Tomomi Endo, Yoshihiro Arimura, Yoshinori Komagata, Toshiko Ito-Ihara, Hajime Kono, Kazuo Suzuki, Shunya Uchida, Yoshitomo Hamano, Shouichi Fujimoto, Janak de Zoysa, Annette Bruchfeld, Sarah L awman, Rachel B. Jones, David Jayne, Kim Mynard, Rona M. Smith, Simon Bond, Rainer Klocke, Tim Doulton, Charles Pusey, Brian Camilleri, Jacqueline Andrews, Alastair Ferraro, Peter Lanyon, Raashid Luqmani, Caroline Wroe, Lorraine Harper, Reem Al-jayyousi, Chee Kay Cheung, Lindsy Forbess, Carol A. Langford, Robert Spiera, Ulrich Specks, Ora Gewurz-Singer, Vimal Derebail, Patrick Nachman, Naomi Amudala, Carol A. McAlear, Peter A. Merkel, Rennie L. Rhee, Antoine G. Sreih, Larry W. Moreland, Curry L. Koening
Institutions: University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Hospital Clínic de Barcelona, Addenbrooke's Hospital, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, University of Pennsylvania, University of Pittsburgh, Cambridge Clinical Trials Unit, Royal Adelaide Hospital, Royal Brisbane and Women's Hospital, Mount Sinai Hospital, University of Toronto, McMaster University, Charles University, Cork University Hospital, University of Parma, Chiba University, Kitano Hospital, Kyorin University, Kyoto Prefectural University of Medicine, Okayama University, Teikyo University Hospital, Tokyo Metropolitan Geriatric Hospital, University of Miyazaki, North Shore Hospital, Karolinska University Hospital, Karolinska Institutet, Royal Sussex County Hospital, Dudley Group NHS Foundation Trust, East Kent Hospitals University NHS Foundation Trust, Imperial College London, Ipswich Hospital, Leeds Teaching Hospitals NHS Trust, University of Oxford, South Tees Hospitals NHS Foundation Trust, University of Birmingham, University Hospitals of Leicester NHS Trust, Cedars-Sinai Medical Center, Cleveland Clinic, Hospital for Special Surgery, Mayo Clinic, University of Michigan, University of North Carolina at Chapel Hill, University of Utah
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7204750904