Real-World experience of rituximab therapy in anca-associated vasculitis according to renal involvement anca ilişkili vaskülitte renal tutuluma göre rituksimab tedavisi: gerçek yaşam deneyimi

Abstract

To evaluate treatment persistence, efficacy, and safety of rituximab (RTX) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), with a specific focus on the impact of renal involvement. Methods: In this multicenter, retrospective cohort study, 214 AAV patients who received at least one RTX dose between 2012 and 2024 were analyzed. Patients were stratified based on renal involvement. The primary endpoint was RTX retention, defined as the time from the first infusion to permanent discontinuation for any cause. Secondary endpoints included remission, relapse, and infection-related discontinuations. Clinical characteristics, treatment indications (induction or maintenance), cumulative RTX doses, and safety outcomes were compared between renal and non-renal groups using descriptive statistics and survival analyses. Results: Among the cohort, 132 patients (61.7%) had renal involvement and 82 (38.3%) had non-renal involvement. The median RTX treatment duration was 24 months. RTX was used for maintenance in 72.4% of patients and for induction in 49% of patients. Drug retention did not differ significantly between renal and non-renal groups (log-rank p=0.608). Infections were the most frequent cause of RTX discontinuation (38.2% vs. 34.8%). Hypogammaglobulinemia occurred in 17.4% and 15.9% of patients, respectively (p=0.460). Mortality rates were comparable between groups (9.8% vs. 8.5%, p=0.475). Despite higher prior cyclophosphamide exposure in renal patients (12.1% vs. 3.7%, p=0.026), overall treatment outcomes were similar. Conclusion: RTX demonstrated sustained treatment persistence and an acceptable safety profile across AAV phenotypes, independent of renal involvement. These findings emphasize that RTX can serve as a phenotype-independent long-term therapeutic option, although vigilant infection monitoring remains crucial in all patients.