Modern rheumatology · 2026
Rituximab versus intravenous cyclophosphamide for anti-neutrophil cytoplasmic antibody-associated vasculitis with severe renal impairment: A multicentre REVEAL cohort study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Miyake Hirofumi, Okazaki Ayana, Matsuda Shogo, Masuda Yuichi, Kotani Takuya, Hatta Muneyuki, Shiomi Mayu, Watanabe Ryu, Hashimoto Motomu, Oka Hideki, Sumitomo Shuji, Jo Kaho, Fujiki Yohei, Yamamoto Wataru, Taniguchi Tomoki, Shoji Mikihito, Manabe Atsushi, Hiwa Ryosuke
Аннотация
OBJECTIVES: To compare the efficacy and safety of rituximab (RTX) to those of intravenous cyclophosphamide (IVCY) as remission induction therapy in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and severe renal impairment.
METHODS: Using the REVEAL cohort, this retrospective multicentre study enrolled 96 newly diagnosed patients with AAV and an estimated glomerular filtration rate of < 30 ml/min/1.73 m2. The patients were divided into RTX and IVCY groups. Matching weights were used to adjust for baseline characteristics. The primary outcome was a 2-year composite of all-cause mortality or end-stage kidney disease (ESKD). Secondary outcomes included all-cause mortality, ESKD, relapse, and hospitalisation-requiring infections. Outcomes were assessed using multivariable Cox proportional hazards models.
RESULTS: In the weighted population, the hazard ratio for RTX versus IVCY was 0.73 (95% confidence interval: 0.31-1.72) for the primary composite outcome, with no significant intergroup difference. Similarly, intergroup differences in the hazard ratios for all-cause mortality, ESKD, relapses, and hospitalisation-requiring infections were not significant.
CONCLUSIONS: RTX and IVCY demonstrated comparable efficacy in preventing mortality and ESKD in this high-risk population. RTX is a viable option for patients with AAV and severe renal impairment.
METHODS: Using the REVEAL cohort, this retrospective multicentre study enrolled 96 newly diagnosed patients with AAV and an estimated glomerular filtration rate of < 30 ml/min/1.73 m2. The patients were divided into RTX and IVCY groups. Matching weights were used to adjust for baseline characteristics. The primary outcome was a 2-year composite of all-cause mortality or end-stage kidney disease (ESKD). Secondary outcomes included all-cause mortality, ESKD, relapse, and hospitalisation-requiring infections. Outcomes were assessed using multivariable Cox proportional hazards models.
RESULTS: In the weighted population, the hazard ratio for RTX versus IVCY was 0.73 (95% confidence interval: 0.31-1.72) for the primary composite outcome, with no significant intergroup difference. Similarly, intergroup differences in the hazard ratios for all-cause mortality, ESKD, relapses, and hospitalisation-requiring infections were not significant.
CONCLUSIONS: RTX and IVCY demonstrated comparable efficacy in preventing mortality and ESKD in this high-risk population. RTX is a viable option for patients with AAV and severe renal impairment.