Abstract Objectives To compare the efficacy and safety of rituximab (RTX) to those of intravenous cyclophosphamide (IVCY) as remission induction therapy in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and severe renal impairment. Methods Using the REVEAL cohort, this retrospective multicentre study enrolled 96 newly diagnosed patients with AAV and an estimated glomerular filtration rate of 30 mL/min/1.73 m2. The patients were divided into RTX and IVCY groups. Matching weights were used to adjust for baseline characteristics. The primary outcome was a 2-year composite of all-cause mortality or end-stage kidney disease (ESKD). Secondary outcomes included all-cause mortality, ESKD, relapse, and hospitalisation-requiring infections. Outcomes were assessed using multivariable Cox proportional hazards models. Results In the weighted population, the hazard ratio (HR) for RTX versus IVCY was 0.73 (95% confidence interval: 0.31–1.72) for the primary composite outcome, with no significant intergroup difference. Similarly, intergroup differences in the HRs for all-cause mortality, ESKD, relapses, and hospitalisation-requiring infections were not significant. Conclusions RTX and IVCY demonstrated comparable efficacy in preventing mortality and ESKD in this high-risk population. RTX is a viable option for patients with AAV and severe renal impairment.
Miyake et al. (2025) studied this question.