Kidney Week

Abstract: SA-PO0820

Kidney Outcomes After Combining Rituximab with Cyclophosphamide Compared with Rituximab Alone: Strategy in ANCA-Associated Vasculitis with Rapidly Progressive Glomerulonephritis

Session Information

• Glomerular Management: Real-World Lessons and Emerging Therapies
  November 08, 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

• Chung, James L., Massachusetts General Hospital, Boston, Massachusetts, United States

James L. Chung, MA

• Jeyabalan, Anushya, Massachusetts General Hospital, Boston, Massachusetts, United States

Anushya Jeyabalan, MD

• Al Jurdi, Ayman, Massachusetts General Hospital, Boston, Massachusetts, United States

Ayman Al Jurdi, MD, FASN

• Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States

Harish Shanthanu Seethapathy, MD, MBBS

• Aaron, Sydney, Massachusetts General Hospital, Boston, Massachusetts, United States

Sydney Aaron

• Sauvage, Gabriel, Massachusetts General Hospital, Boston, Massachusetts, United States

Gabriel Sauvage

• Laliberte, Karen A., Massachusetts General Hospital, Boston, Massachusetts, United States

Karen A. Laliberte, RN

• Niles, John, Massachusetts General Hospital, Boston, Massachusetts, United States

John Niles, MD

• Efe, Orhan, Massachusetts General Hospital, Boston, Massachusetts, United States

Orhan Efe, MD

Group or Team Name

• Vasculitis and Glomerulonephritis Center.

Background

The efficacy of combining rituximab (RTX) with cyclophosphamide (CYC) vs. rituximab (RTX) alone strategy in ANCA-associated vasculitis (AAV) with rapidly progressive glomerulonephritis (RPGN) is unknown.

Methods

We conducted a multi-center retrospective study of patients with AAV with RPGN who were treated with RTX+CYC vs. RTX alone in combination with steroids for induction treatment in 2017-2021. Use of plasma exchange (PLEX) was not an exclusion criterion. Patients who used other concomitant immunosuppressive agents were excluded. Primary outcomes were improvement in eGFR and risk of relapse at 1, 2, and 5 years. Other outcomes included adverse events, including death and severe infections.

Results

A total of 28 and 42 patients were included in the RTX and RTX+CYC groups, respectively. Baseline characteristics are summarized in Table 1. At presentation, the RTX+CYC group had lower nadir eGFR and % normal glomeruli and a higher rate of kidney replacement therapy (KRT) requirement (Table 1). Median eGFR improved by 17 (IQR 8-27) mL/min/1.73 m² in the RTX group and 15 (IQR 8-26) in the RTX+CYC group at 1 year (p=0.49) (Fig.1) and remained stable at 2 years. Among patients who needed KRT, 75% (3/4) vs. 73% (8/11) became KRT-independent in RTX vs. RTX+CYC groups, respectively. During follow-up, 25% (7/28) in the RTX group had at least one relapse, while none relapsed in RTX+CYC group. Severe infections and death occurred in 46% (13/28) vs. 41% (17/42) and 14% (4/28) vs. 12% (5/42) in RTX vs. RTX+CYC groups, respectively.

Conclusion

In AAV with severe RPGN, treatment with RTX+CYC vs. RTX alone led to a similar renal recovery, despite RTX+CYC group having more severe renal disease at presentation. Combining RTX+CYC might reduce the risk of AAV relapse. Larger and randomized studies are needed.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025w8x39a51