ArticlePloS one2026
Clinical outcomes after relapse during rituximab-based maintenance in ANCA-associated vasculitis: A single-center retrospective cohort study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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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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