Real world experience

A recently published study in Clinical and Experimental Rheumatology offers new real-world data from the University of Lübeck on the treatment of GPA and MPA. The official title of the article is “Real-world outcomes of rituximab- and cyclophosphamide-based induction therapy regimens alone and in combination over 24 months in ANCA-associated vasculitis”. Which is a bit misleading for patients because according to the Chapel Hill classification AAV is comprised of GPA, MPA and EGPA while the study was about GPA and MPA patients only.

The research compares the effectiveness of three commonly used induction therapies.

Study Overview

The retrospective cohort study* followed 166 patients (197 with GPA and 69 with MPA) over a 24-month period, including individuals newly diagnosed with AAV or experiencing a relapse. Patients received one of three treatments:
– Rituximab (RTX) alone followed by RTX maintenance
– Rituximab and cyclophosphamide (RTX/CYC) followed by RTX maintenance
– Cyclophosphamide followed by azathioprine (CYC-AZA)
Patients with prior treatment using RTX or CYC were excluded from the study.

Conclusion

The study concludes that rituximab alone is as effective as rituximab/cyclophosphamide combination or cyclophosphamide followed by azathioprine in inducing and maintaining remission in AAV patients, including those with severe kidney involvement. These findings support the use of rituximab as a strong stand-alone option in real-world clinical settings.

Detailed findings

– Complete remission (no disease activity and no steroid use) was achieved by:
   – 20% and 35% of patients in the RTX group at 12 and 24 months
   – 22% and 33% in the RTX/CYC group
   – 3% and 9% in the CYC-AZA group

– Most patients reached remission at some point during the 24-month period while still on steroids:
   – RTX: 88%, RTX/CYC: 87%, CYC-AZA: 81%

– RTX alone led to a lower relapse rate in patients with granulomatosis with polyangiitis (GPA).

– In patients with severe kidney disease, RTX alone was as effective as the other two treatment strategies.

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What does this mean for patients?

These findings suggest that rituximab on its own may be enough to control severe vasculitis, without the need for additional chemotherapy drugs like cyclophosphamide. This could lead to safer treatment plans with fewer long-term side effects, especially for patients with GPA or those hoping to avoid high steroid doses.

As always, treatment decisions should be made in close consultation with your healthcare team. This study adds to a growing body of evidence that supports more personalized and targeted treatment options for vasculitis.

The full study was published in *Clinical and Experimental Rheumatology (2025)* and was based on the real-life experiences of patients treated at the University of Lübeck, Germany.

You can find the article as published in PubMed here: