The risk of kidney failure and death is similar among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) who received rituximab- or cyclophosphamide-based strategies for remission induction, according to a study published in Arthritis & Rheumatology.

Moreover, the study showed that similarities in outcomes persisted across clinically relevant disease subgroups.

“Overall, these data provide evidence to reassure clinicians and patients that choice of either treatment strategy for remission induction strategy is likely to yield similar risks of kidney failure and death over five years of follow-up,” the study’s authors said.

Fully adjusted analyses revealed a similar risk of kidney failure or death among patients treated with rituximab- or cyclophosphamide-based treatment regimens at 1 year (hazard ratio [HR], 0.86; 95% CI, 0.42-1.76), 2 years (HR, 0.85; 95% CI, 0.42-1.72), and 5 years (HR, 1.03; 95% CI, 0.55-1.93).

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Furthermore, the risk of kidney failure or death was similar in both groups after propensity score matching at 1 year (HR, 0.93; 95% CI, 0.47-1.83), 2 years (HR, 0.90; 95% CI, 0.39-2.08), and 5 years (HR, 1.05; 95% CI, 0.55-1.99).

The risk of kidney failure or death remained similar according to the presence of renal involvement, severe renal involvement, or major organ involvement, as well as during sensitivity analysis or when analyzing the risk of kidney failure or death separately.

In addition, the study found that patients who received rituximab more often discontinued or tapered their dose of prednisone to 5 mg/day or less than those who received cyclophosphamide.

The study enrolled 595 patients of the Mass General Brigham AAV cohort (mean age, 61 years, 58% male), of which 60% had received a rituximab-based regimen and 40% had received a cyclophosphamide-based regimen. Most (70%) patients had myeloperoxidase-ANCAs.


Wallace ZS, Fu X, Cook C, et al. The comparative effectiveness of rituximab- vs cyclophosphamide-based remission induction strategies in ANCA-associated vasculitis for the risk of kidney failure and mortality. Arthritis Rheumatol. Published online April 3, 2023. doi:10.1002/art.42515