Gulati K, Edwards H, Prendecki M, et al. - In patients suffering from severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, administration of combination immunosuppressive therapy may allow glucocorticoid avoidance and afford rapid and prolonged disease control.

• This is a retrospective analysis of 64 patients with life-threatening ANCA-associated vasculitis managed with a combination regimen of rituximab, low-dose intravenous cyclophosphamide, oral glucocorticoids, and plasma exchange.

• At six months, disease remission was achieved in 94% of patients, and 67% of patients who needed dialysis recovered independent renal function.

• Long-term follow-up revealed overall patient survival 85%, and freedom from end-stage kidney disease in 69% of patients, which compares favorably to a historic cohort with severe disease managed with a conventional induction regimen.

• Prolonged B cell depletion and low rates of relapse were noted with combination treatment; continuous remission at month 36 was evident in 87% of patients.

• Rate of serious infection was 0.28 infections/patient/year, implying that combination treatment is not related to an enduring risk of infection.