We discussed the recent NEJM trial called RITUXIVAS
( Linked below)
Take home points
1. Randomized controlled double blinded trial that was comparing IV Cytoxan induction arm to IV Rituximab + low dose IV cytoxan arm and follow up for up to 12 months.
2. It was a random assignment via a 3:1 ratio ( rituximab to cytoxan)
3. everyone got steroids
4. Primary end points were sustained remission
5. Result: A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events.
1.First study to compare SEVERE anca vasculitis in a randomized fashion that involves Rituximab
2. Patients included elderly as well which is where the choice of treatment becomes an issue.
1. Sample size
2. The Rituximab arm was sicker( more patients on dialysis)
3. The Rituximab arm received cytoxan as well ( unclear why they chose to do this, perhaps ethical reasons)
4. Net immunosuppresion was likely higher in the Rituximab arm ( dialysis , likely had TPE, and also cytoxan) making more infectious risks.
5. Data on IV cytoxan itself is poor in ANCA vasculitis.
6. Didn't really answer the question if Rituximab alone is good enough when compared to Cytoxan, and less toxic
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