Clinical outcomes after relapse during rituximab-based maintenance in ANCA-associated vasculitis: A single-center retrospective cohort study
- 1Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
- 2Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, Okazaki, Aichi, Japan
- 3Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
Abstract
Relapse during rituximab (RTX)-based maintenance therapy remains a clinical problem in ANCA-associated vasculitis (AAV). Mycophenolate mofetil (MMF) has been investigated as an alternative; however, evidence regarding its use after relapse during RTX-based maintenance is limited. We aimed to retrospectively describe clinical outcomes in patients with AAV who relapsed during RTX-based maintenance according to whether MMF was included in the initial post-relapse treatment strategy. We retrospectively analyzed 17 patients with AAV who experienced their first relapse during RTX-based maintenance after remission induction. Baseline was defined as the time of the first relapse. Post-relapse treatment included glucocorticoid escalation and/or RTX re-administration; patients were categorized according to whether MMF was additionally included in the initial treatment strategy (MMF-added group, n = 9; MMF-not-added group, n = 8). All outcomes were evaluated descriptively. In the MMF-added group, MMF was initiated at a median of 0.4 months after the first relapse (interquartile range [IQR], 0.3–0.4 months; range, 0.3–0.5 months). The median age was 76 years (IQR, 73–81 years); 16 patients (94.1%) were MPO-ANCA-positive. During a median follow-up of 28 months (IQR, 21–33 months), all patients achieved remission after post-relapse treatment intensification. No second relapse occurred in the MMF-added group, whereas three patients in the MMF-not-added group experienced a second relapse. Glucocorticoids were discontinued in all nine patients in the MMF-added group, whereas in the MMF-not-added group, all eight patients continued glucocorticoids while they were managed without MMF. Severe infections requiring hospitalization occurred in none of the patients in the MMF-added group and in three patients in the MMF-not-added group. Because treatment allocation was non-randomized and post-relapse treatment strategies differed with respect to RTX scheduling, concomitant therapies, and physician-directed glucocorticoid tapering, the independent effect of MMF could not be determined. Therefore, these descriptive and hypothesis-generating findings warrant confirmation in future prospective studies.
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BibTeX
@article{yamaguchi2026clinical,
title = {{Clinical outcomes after relapse during rituximab-based maintenance in ANCA-associated vasculitis: A single-center retrospective cohort study}},
author = {Makoto Yamaguchi and Hirokazu Sugiyama and Hiroshi Kinashi and Keisuke Kamiya and Genri Tagami and Masayoshi Toda and Takayuki Katsuno and Takahiro Imaizumi and Shogo Banno and Yasuhiko Ito and Takuji Ishimoto},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0357836},
url = {https://doi.org/10.1371/journal.pone.0357836},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical outcomes after relapse during rituximab-based maintenance in ANCA-associated vasculitis: A single-center retrospective cohort study
AU - Makoto Yamaguchi
AU - Hirokazu Sugiyama
AU - Hiroshi Kinashi
AU - Keisuke Kamiya
AU - Genri Tagami
AU - Masayoshi Toda
AU - Takayuki Katsuno
AU - Takahiro Imaizumi
AU - Shogo Banno
AU - Yasuhiko Ito
AU - Takuji Ishimoto
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0357836
UR - https://doi.org/10.1371/journal.pone.0357836
AB - Relapse during rituximab (RTX)-based maintenance therapy remains a clinical problem in ANCA-associated vasculitis (AAV). Mycophenolate mofetil (MMF) has been investigated as an alternative; however, evidence regarding its use after relapse during RTX-based maintenance is limited. We aimed to retrospectively describe clinical outcomes in patients with AAV who relapsed during RTX-based maintenance according to whether MMF was included in the initial post-relapse treatment strategy. We retrospectively analyzed 17 patients with AAV who experienced their first relapse during RTX-based maintenance after remission induction. Baseline was defined as the time of the first relapse. Post-relapse treatment included glucocorticoid escalation and/or RTX re-administration; patients were categorized according to whether MMF was additionally included in the initial treatment strategy (MMF-added group, n = 9; MMF-not-added group, n = 8). All outcomes were evaluated descriptively. In the MMF-added group, MMF was initiated at a median of 0.4 months after the first relapse (interquartile range [IQR], 0.3–0.4 months; range, 0.3–0.5 months). The median age was 76 years (IQR, 73–81 years); 16 patients (94.1%) were MPO-ANCA-positive. During a median follow-up of 28 months (IQR, 21–33 months), all patients achieved remission after post-relapse treatment intensification. No second relapse occurred in the MMF-added group, whereas three patients in the MMF-not-added group experienced a second relapse. Glucocorticoids were discontinued in all nine patients in the MMF-added group, whereas in the MMF-not-added group, all eight patients continued glucocorticoids while they were managed without MMF. Severe infections requiring hospitalization occurred in none of the patients in the MMF-added group and in three patients in the MMF-not-added group. Because treatment allocation was non-randomized and post-relapse treatment strategies differed with respect to RTX scheduling, concomitant therapies, and physician-directed glucocorticoid tapering, the independent effect of MMF could not be determined. Therefore, these descriptive and hypothesis-generating findings warrant confirmation in future prospective studies.
SN - 1932-6203
ER -