A Personalized Rituximab Retreatment Approach Based on Clinical and B-Cell Biomarkers in ANCA-Associated Vasculitis

Area of Science:

• Immunology
• Rheumatology
• Clinical Medicine

Background:

• Time to relapse after rituximab treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is highly variable.
• Optimal retreatment strategies for AAV post-rituximab induction remain unclear.
• Predicting relapse is crucial for effective AAV management.

Purpose of the Study:

• To evaluate clinical and B-cell predictors of relapse in AAV patients treated with rituximab.
• To develop a personalized retreatment algorithm for AAV based on identified predictors.
• To optimize retreatment strategies and minimize unnecessary interventions.

Main Methods:

• Retrospective observational study of 70 rituximab-treated AAV patients over 10 years.
• Complete response (CR) defined as Birmingham Vasculitis Activity Score v3.0 = 0.
• Peripheral B-cell subsets analyzed by flow cytometry; predictors assessed via multivariable Cox regression.

Main Results:

• Concomitant immunosuppressant use, achieving CR, and naïve B-cell repopulation at 6 months were associated with longer time to relapse.
• Personalized retreatment based on these predictors could have avoided unnecessary fixed retreatment in 24% of patients.
• Naïve B-cell repopulation showed superior predictive accuracy (AUC 0.82) compared to ANCA/CD19+ cell return (AUC 0.53).

Conclusions:

• Coprescribing oral immunosuppressants is recommended for all AAV patients.
• Retreatment at 6 months is suggested for patients with incomplete response or absent naïve B cells.
• Patients achieving CR with naïve B-cell repopulation should not receive fixed retreatment, warranting clinical trial investigation.