Recent data continue to support the use of rituximab as the standard of care for maintenance therapy for patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and relapsing disease.

Results from RITAZAREM trial show that repeat-dose rituximab is more effective than azathioprine for preventing relapse among patients with relapsing ANCA-associated vasculitis in whom remission was re-induced with rituximab and glucocorticoids, Rona M. Smith, MD, of the University of Cambridge in the UK, and colleagues reported in the Annals of the Rheumatic Diseases.

RITAZAREM was an international randomized, controlled open-label trial that recruited 188 patients at the time of relapse. All patients received rituximab and glucocorticoids to re-induce remission. Investigators randomly assigned patients who achieved remission to receive intravenous rituximab (1000 mg every 4 months through month 20) or azathioprine (2 mg/kg/day, tapered after month 24). Investigators followed patients for a minimum of 36 months. The primary outcome was time to disease relapse.

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Rituximab was significantly associated with a 59% decreased risk for relapse compared with azathioprine, Dr Smith’s team reported.

With regard to safety, 22% of the rituximab group and 36% of the azathioprine group experienced at least 1 serious adverse event during the treatment period. The investigators observed no between-group differences in the rates of hypogammaglobulinemia or infection.

“These data extend previous reports on the efficacy of rituximab for induction of remission for relapsing disease and confirms the place of rituximab as the standard of care for maintenance therapy,” the authors concluded.

Disclosure: This research was supported by Roche/Genentech. Please see the original reference for a full list of disclosures.


Smith RM, Jones RB, Specks U, et al. Rituximab versus azathioprine for maintenance of remission for patients with ANCA-associated vasculitis and relapsing disease: an international randomised controlled trial. Ann Rheum Dis. Published online March 23, 2023. doi:10.1136/ard-2022-223559