AB0623 A review of the evidence behind the recommendation of rituximab for ANCA associated vasculitis

Background Cyclophosphamide (CYC) is currently used to induce remission in patients with ANCA-associated vasculitis (AAV). Once induction successful Azathioprine (AZA) given as maintenance (1). Concerns surround the use of cyclophosphamide which has an undesirable safety profile, limiting its patients. AZA shown be effective at maintenance, however rates relapse on are high. Rituximab (RTX) a biologic high specificity B cells. Its mechanism action (B cell apoptosis) may mean that it can for both and remission, superior long-term profile. Objectives To conduct systematic review literature determine efficacy rituximab inducing maintaining agent. Methods A was conducted by searching PubMed Cochrane library search phrase “rituximab AND vasculitis”. The following criteria then applied: randomised controlled trial (RCT) English language. Only original papers were accepted if pertained RTX either or remission. Results 1008 initially identified after strategy applied 9 RCTs analysed. RAVE compared CYC 197 AAV double-blind double-dummy trial. result indicated RITUXVAS trial, partially blinded had sample 44 also came same conclusion. Both trials showed initial dose continuous immunosuppression over length. Further published from studies including follow up 24 months no increased adverse events between groups. study multiple occasions irrespective MAINRITSAN1 non-blinded azathioprine 115 AAV. results this than only 5% 29% relapsing. 60 months, who received less likely have relapsed. MAINRITSAN2 there difference fixed vs tailored dose, meaning lower higher dose. MAINRITSAN 3 paper biannual placebo Conclusion sharing similar conclusions. Currently research indicates maintain AZA, superiority yet determined. 1 unblinded protocol data indicating drastically overestimated AZA. Therefore, more needed validate claim maintenance. References [1]Yates, M, et al. 2016. EULAR/ERA-EDTA recommendations management vasculitis. Annals Rheumatic Diseases 75, 1583–1594. doi:10.1136/annrheumdis-2016-209133 Acknowledgements I would like thank Dr Marwan Bukhari his continued support feedback during project. Disclosure Interests None declared