• William F Pendergraft, Frank B Cortazar, Julia Wenger, Andrew P Murphy, Eugene P Rhee, Karen A Laliberte, and John L Niles.
• Joint Nephrology Fellowship Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts, †Division of Nephrology, Department of Medicine,, ‡Vasculitis and Glomerulonephritis Clinic, Division of Nephrology, and, §Categorical Internal Medicine Residency Program, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
• Clin J Am Soc Nephrol. 2014 Apr 1; 9 (4): 736-44.

Background And ObjectivesRemission in the majority of ANCA vasculitis patients is not sustained after a single course of rituximab, and risk of relapse warrants development of a successful strategy to ensure durable remission.Design, Setting, Participants, & MeasurementsA retrospective analysis of ANCA vasculitis patients who underwent maintenance therapy using rituximab-induced continuous B-cell depletion for up to 7 years was performed. Maintenance therapy with rituximab was initiated after achieving remission or converting from other prior maintenance therapy. Continuous B-cell depletion was achieved in all patients by scheduled rituximab administration every 4 months. Disease activity, serologic parameters, adverse events, and survival were examined.ResultsIn the study, 172 patients (mean age=60 years, 55% women, 57% myeloperoxidase-ANCA) treated from April of 2006 to March of 2013 underwent continuous B-cell depletion with rituximab. Median remission maintenance follow-up time was 2.1 years. Complete remission (Birmingham Vasculitis Activity Score [BVAS] = 0) was achieved in all patients. Major relapse (BVAS ≥ 3) occurred in 5% of patients and was associated with weaning of other immunosuppression drugs. Remission was reinduced in all patients. Survival mirrored survival of a general age-, sex-, and ethnicity-matched United States population.ConclusionThis analysis provides evidence for long-term disease control using continuous B-cell depletion. This treatment strategy in ANCA vasculitis patients also seems to result in survival rates comparable with rates in a matched reference population. These findings suggest that prospective remission maintenance treatment trials using continuous B-cell depletion are warranted.

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