Without maintenance therapy, relapses are common in anti-neutrophilic cytoplasmic autoantibody (ANCA )-associated vasculitis (AAV). “We started using maintenance rituximab for AAV around 2006,” said Dr Rona Smith (University of Cambridge, United Kingdom). The drug is already known as an effective treatment for AAV. “We used 2 grams initially, then 1 gram every 6 months for 2 years. Relapse rates were considerably reduced with the repeat dosing. But historically, azathioprine has been a standard for relapsing disease.
The RITAZAREM trial compared these approaches head-to-head,” Dr Smith explained. A total of 170 AAV patients in remission were randomised 1:1 to receive either 1,000 mg rituximab every 4 months for 5 doses or 2 mg/kg of azathioprine per day. Primary endpoint was time to relapse. Follow-up was done over at least 36 months. Baseline characteristics included a median age of 59 years, past disease duration 5.3 years, 28% patients who were positive for myeloperoxidase ANCA, and 72% positive for anti-proteinase 3 ANCA.
Results showed that at 20 months from randomisation 13% of patients in the rituximab arm had suffered from a relapse, in contrast to 38% in the azathioprine group. These relapses were categorised as ‘major’ in 18% (rituximab) versus 38% (azathioprine) of cases. Severe adverse events ≥1 appeared in 22% of rituximab-treated patients and 36% under azathioprine. The rate for serious infections was also lower with rituximab. “We would like to see these findings reflected in clinical practice. However, we recognise that rituximab is more expensive than azathioprine, which may affect how it is actually used in relapsing disease across the globe,” Dr Smith expressed.
- Smith R, et al. Abstract 0806. ACR 2019. 8-13 November, Atlanta (GA/USA).
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Table of Contents: ACR 2019
Featured articles
Late-Breaking Abstracts
Lowest risk of infection after therapy with an IL-12/IL-23 blocker
Calcium pyrophosphate deposition disease: an independent risk factor for cardiovascular complications
Proteome abnormalities improve prediction of RA development
RA patients in remission benefit from continued therapy with conventional DMARDs
Selective IL-23 blocker shows remarkable efficacy in patients with psoriatic arthritis
Corticosteroid therapy in GCA: higher platelets – lower relapse rate
Spotlight on Rheumatoid Arthritis
Filgotinib promising in RA patients naïve to methotrexate
Sustained efficacy of monotherapy with upadacitinib after 48 weeks
Biologics show similar activity in patients with elderly-onset RA
Tocilizumab outperforms rituximab in RA patients with low level of synovial B cell infiltration
Treatment decisions should not be guided by ultrasound findings
Cancer treatment with checkpoint inhibitors in RA patients?
What is Hot in Systemic Lupus Erythematosus
Anifrolumab succeeds in second phase 3 trial in SLE
Depression closely related to fatigue in SLE patients
Spondyloarthritis – The Beat Goes On
Psoriasis onset determines sequence of symptoms
Higher psychiatric comorbidity in women with PsA
JAK1 inhibition shows remarkable efficacy in AS
CARDAS study shows increased prevalence of cardiac valvular disorders in AS patients
Osteoarthritis – State-of-the-Art
Hand OA: low-dose corticosteroids improve symptoms
Opioids: no quality of life benefits for OA patients
Walking speed is a predictor of mortality in patients with knee OA
Reproductive Issues in Rheumatic Disease
Few serious infections in offspring with exposure to non-TNFi biologics or tofacitinib
Prevention of congenital heart block may be possible with hydroxychloroquine
TNFi for RA during pregnancy – to stop or not to stop?
Vasculitis – Novel Treatment Modalities
Rituximab maintenance superior to azathioprine in ANCA-associated vasculitis
Prolonged remission after stop of tocilizumab for patients with giant cell arteritis
Best of the Posters
Antifibrotic therapy slows disease progression independent of corticosteroid use
Fibromyalgia patients often experienced abuse in childhood
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