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MO259: Maintenance Therapies for Anti-Neutrophil Cytoplasmic Antibody Small-Vessel Vasculitis: A Network Meta-Analysis


 
 
 Over the past two decades, considerable progress has been made in maintaining remission in patients with anti-neutrophil cytoplasmic antibody (ANCA) vasculitis using a variety of medications, including rituximab, azathioprine, mycophenolate, methotrexate, and glucocorticoids. However, although survival has improved dramatically over the last decades, relapse rates remain significant for certain patients, stressing the need for advocation of new therapeutic strategies. The aim of this study was to compare the efficacy and safety of different regimens used for maintenance of remission in patients with ANCA-vasculitis.
 
 
 
 This network meta-analysis studied adult patients with ANCA-vasculitis in complete remission, who were maintained with various regimens, excluding patients with eosinophilic granulomatosis with polyangiitis, and those who have ended up in end-stage kidney disease. Outcomes of interest included relapse (any/major), relapse-free survival and adverse effects. PubMed, Scopus, Web of Science, CENTRAL, Clinicaltrials.gov and Google Scholar were systematically searched from inception.
 
 
 
 Overall, the meta-analysis was based on 10 reports, describing the outcomes of 7 RCTs including 752 patients with ANCA-vasculitis. Compared with rituximab, relapse-free survival was significantly worse with the use of azathioprine {HR 2.11 [95% confidence interval (CI) 1.19–3.74]}, methotrexate [HR 2.51 (95% CI 1.24–5.08)] and mycophenolate mofetil [HR 3.57 (95% CI 1.70–7.46)]. Compared with mycophenolate mofetil, better outcomes were estimated for azathioprine [HR 0.59 (95% CI 0.37–0.94)], cyclophosphamide [HR 0.39 (95% CI 0.20–0.75)] and leflunomide [HR 0.30 (95% CI 0.11–0.84)]. Compared with rituximab a higher relapse risk was estimated for azathioprine [OR 2.15 (95% CI 1.00–4.59)] and mycophenolate mofetil [OR 4.42 (95% CI 1.63–11.94)]. A higher risk of major relapse was calculated for azathioprine [OR 2.39 (95% CI 1.10–5.19)], methotrexate [OR 3.18 (95% CI 1.14–8.89)] and mycophenolate mofetil [OR 5.20 (95% CI 1.65–16.37)] compared with rituximab. The rates of serious adverse effects did not differ significantly among interventions.
 
 
 
 Rituximab appears predominant in maintaining remission in patients with ANCA-vasculitis with no cost in adverse events.
