Rituxan in ANCA-associated vasculitis

Wegener’s granulomatosis and microscopic polyangiitis are classified as antineutrophil cytoplasmic antibody (ANCA)−associated vasculitides as most patients have antibodies against proteinase 3 or myeloperoxidase.The ANCA-associated vasculitides affect small-to-medium-size blood vessels, with a predilection for the respiratory tract and kidneys. Without treatment mortality is very high and mostly the norm.

Cyclophosphamide and glucocorticoids have been the standard therapy for remission induction for decades. While this treatment is effective in controlling the disease and inducing temporary remission in a majority of the patients, the side effects of cyclophosphamide (leucopenia, infertility, bladder cancer) are very severe and limiting. And, a search for a suitable alternative to cyclophosphamide for inducing disease remission in these patients with fewer side effects is ongoing.

In the following slides I have summarized two landmark studies that evaluated Rituxan in ANCA associated vasculitis as an alternative to cyclophosphamide: