2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis (Part 8)
Allow me to continue with our discussion of the guidelines of the American College of Rheumatology (ACR) in relation to the antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides (AAV).
Let me again emphasize that ANCA-AAV is a group of diseases composed of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).
When it comes to remission treatment, for patients with severe GPA/MPA and the disease has entered remission after treatment with cyclophosphamide or rituximab, the experts are conditionally recommend the use of rituximab over methotrexate or azathioprine for maintenance.
Rituximab is linked with a lower relapse rate compared to azathioprine, if used as a remission maintenance after remission induction with cyclophosphamide.
Methotrexate and azathioprine may have similar efficacy rates when used as remission maintenance.
That is why, rituximab is preferred over methotrexate or azathioprine.
However, long-term safety issues for methotrexate and azathioprine, and cost and other factors may dictate the limit of rituximab use.
Different dosing strategy for rituximab are used for remission maintenance, including intravenous (IV) 500 mg every 6 months, IV 1,000 mg every 4 months, and IV 1,000 mg every 6 months.
There is no trial conducted to determine the optimal dose of rituximab for maintenance.
If methotrexate or azathioprine treatment is being used for maintenance, the patient’s health status, preferences, and values should guide the doctor for the treatment choices.
Next week we will be continuing with our discussion on the recommendations for remission maintenance for ANCA-AAV patients.