Rituximab Dosing Regimen for Granulomatosis with Polyangiitis

Remission Induction Therapy

For active, severe granulomatosis with polyangiitis (GPA), rituximab is conditionally recommended over cyclophosphamide for remission induction due to comparable efficacy with potentially fewer long-term side effects 1
Alternatively, some clinicians use 1,000 mg on days 1 and 15 (two doses) for adult patients 1
For pediatric patients, the recommended dose is 375 mg/m² IV weekly for 4 doses or 575 mg/m² for patients with body surface area ≤1.5m² (750 mg/m² for BSA >1.5m²) given as 2 doses on days 1 and 15 1

After achieving disease control with induction therapy, maintenance therapy with rituximab consists of 500 mg IV every 6 months 1, 2
The MAINRITSAN protocol recommends 500 mg at complete remission and then at months 6, 12, and 18 2

Prophylaxis against Pneumocystis jirovecii pneumonia with trimethoprim/sulfamethoxazole is recommended during rituximab therapy 3
Rituximab may be particularly preferred over cyclophosphamide in patients who wish to preserve fertility, as cyclophosphamide is associated with reduced ovarian reserve and male infertility 3

While rituximab is effective for GPA, the evidence for its use in EGPA is less robust 3
For patients with active, severe EGPA, cyclophosphamide or rituximab is conditionally recommended over mepolizumab for remission induction 4
For maintenance therapy in EGPA, rituximab (500 mg every 6 months) may be considered, particularly in those who achieved remission with rituximab induction 5