Abstract: FR-PO0820
Comparative Outcomes of Rituximab- vs. Cyclophosphamide-Based Induction Regimens in ANCA-Associated Renal Vasculitis: Systematic Review and Meta-Analysis
Session Information
- Glomerular Clinical Trials: From Data to Impact
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Leesutipornchai, Thiratest, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Ratchataswan, Thanaporn, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Tanariyakul, Manasawee, University of Hawai'i at Manoa, Honolulu, Hawaii, United States
- Manolopoulou, Marika, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background
The treatment of ANCA-associated vasculitis (AAV) with renal involvement remains poorly defined. Cyclophosphamide (CYC) is the conventional induction agent used by nephrologists, but recent studies suggest rituximab (RTX) as an alternative. We conducted a systematic review and meta-analysis to compare the outcomes of RTX versus CYC-based induction regimens in ANCA-associated renal vasculitis.
Methods
We searched MEDLINE, EMBASE, and the Cochrane Library from inception to March 2025. Included studies were randomized controlled trials (RCTs) and cohort studies evaluating relapse, remission, progression to end-stage renal disease (ESRD) or death in patients with ANCA-associated renal vasculitis treated with RTX versus CYC-based induction regimens. We used random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CIs).
Results
Two RCTs and five cohort studies with 861 patients (417 in the RTX group and 444 in the CYC group) were included. No significant difference in relapse incidence was found between the RTX and CYC groups (pooled RR 1.60, 95% CI: 0.79–3.26, p=0.19, I2=58.0%). Similarly, remission rates showed no significant difference (pooled RR 1.07, 95% CI: 0.74–1.56, p=0.71, I2=71.6%). The risk of ESRD or mortality did not significantly differ between the groups (pooled RR 0.79, 95% CI: 0.61–1.03, p=0.08, I2=0.0%). Subgroup analysis of patients with severe renal involvement also revealed no significant difference in these outcomes.
Conclusion
Our meta-analysis suggests no significant difference in major outcomes including relapse, remission, risk of ESRD, or mortality between RTX-based and CYC-based induction regimens for ANCA-associated renal vasculitis, including patients with severe renal involvement. These results suggest RTX may be considered as an alternative to CYC in managing ANCA-associated renal vasculitis without compromising outcomes.