Rituximab Therapy in ANCA-Associated Vasculitis

Remission Induction and Maintenance

The American College of Rheumatology recommends rituximab as a first-line treatment option alongside glucocorticoids for remission induction in severe ANCA-associated vasculitis, particularly in relapsing disease, women of childbearing age, or when cyclophosphamide poses risks 1
Rituximab is equally effective to cyclophosphamide for remission induction in severe ANCA-associated vasculitis and is superior for relapsing disease 1
The standard regimen for rituximab induction is 375 mg/m² IV weekly for 4 weeks 1, 2
The European League Against Rheumatism recommends rituximab 500 mg IV every 6 months for at least 18 months for maintenance therapy 3, 2
Rituximab is superior to azathioprine for maintenance therapy and should be preferred whenever possible 3, 2

Rituximab is preferable to cyclophosphamide in patients wishing to preserve reproductive potential, as cyclophosphamide causes reduced ovarian reserve, ovarian failure, and male infertility 1, 2
For severe EGPA relapse after cyclophosphamide, rituximab is conditionally recommended over repeat cyclophosphamide 6

Pneumocystis jirovecii prophylaxis with trimethoprim/sulfamethoxazole is required during rituximab therapy 1, 2
Monitor immunoglobulin levels every 6 months during rituximab therapy 7
Do not use ANCA titers to guide treatment changes; use structured clinical assessment instead 5, 4