Rituximab for IgA Vasculitis: Guideline Recommendations and Evidence

Introduction to Rituximab Use

• The KDIGO and EULAR/ERA-EDTA guidelines address AAV, but not IgA vasculitis, and rituximab has FDA approval and strong guideline support for AAV, according to the Kidney International and Annals of the Rheumatic Diseases 1, 2

Baseline Assessments and Monitoring

• Baseline assessments should include IgG, IgA, IgM levels, complete blood count, renal function, urinalysis with 24-hour proteinuria, and hepatitis B and C screening, as recommended by the Kidney International and Annals of the Rheumatic Diseases 1, 2
• Follow-up monitoring should include immunoglobulin levels every 6 months during rituximab therapy, according to the Kidney International 1

Considerations for Rituximab Use

• Rituximab may be considered for refractory or relapsing IgA vasculitis, severe nephritis with progressive renal impairment, contraindications to conventional immunosuppressive therapy, and glucocorticoid-dependent disease, with cost considerations in mind, as noted in the Annals of the Rheumatic Diseases 2

Rituximab for IgA Vasculitis: Evidence and Guidelines

Introduction to IgA Vasculitis and ANCA-Associated Vasculitis

• The KDIGO and EULAR/ERA-EDTA guidelines address ANCA-associated vasculitis (AAV), which is distinct from IgA vasculitis, and do not provide recommendations for IgA vasculitis treatment 3, 4

Evidence for Rituximab in IgA Vasculitis

• The provided guidelines from Kidney International and Annals of the Rheumatic Diseases distinguish between IgA vasculitis and ANCA-associated vasculitis, with the latter including granulomatosis with polyangiitis and microscopic polyangiitis 3, 5

Guideline Recommendations

• The EULAR/ERA-EDTA guidelines, as reported in Annals of the Rheumatic Diseases, do not provide recommendations for IgA vasculitis treatment, highlighting the need for separate consideration of this condition 4