Maintenance of Remission in ANCA-vasculitis: MAINRITSAN study. Save

It is well known that ANCA-associated vasculitides can be hard to control and relapses are common. The choice of maintenance therapy is rather limited and therapies are not always effective.

In the past, the randomized controlled prospective MAINRISTAN trial demonstrated superiority of rituxan (RTX) over azathioprine for maintenance of remission at 22 months in patients with ANCA-associated vasculitis after CYC remission induction.

Today, at the ACR 2016 annual meeting plenary session, Dr. Benjamin Terrier presented long term outcomes at 60 months of MAINRISTAN (Abstract 1955). Of 115 patient in the initial cohort, 110 were available for analysis. Four patients in AZA died.

The bottom line was that major relapse-free survival rates were better (71.9%) in RTX vs 49.4% in AZA group ( p= 0.003).

Severe infections (predominantly pneumonia and bronchitis) were slightly higher in RTX, but cancers (skin predominantly) were seen more in the AZA group.

The study concluded that at 60 months, RTX remained significantly superior to AZA in maintaining remission and RTX was associated with better survival. It was suggested to monitor ANCA for guidance of treatment duration.