Maintenance treatment for antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides

Most antineutrophil cytoplasm antibody (ANCA)-associated vasculitides are controlled, when they are adequately treated with a combined induction-remission phase followed by maintenance therapy. The latter classically consisted of immunosuppressants, such as azathioprine or methotrexate, but new therapeutic approaches deserve consideration. Because rituximab, a chimeric murine-human monoclonal IgG1 antibody directed against CD20 expressed on B lymphocytes, has a prolonged effect after inducing remission, some authors do not propose maintenance treatment and treat only relapses. Our approach, based on randomized controlled trials, proposes maintaining remission with rituximab. Treatment duration has not yet been clearly established and could probably be based on clinical parameters (previous relapses), the ANCA subtypes and their persistence over time. The role of corticosteroids to prevent relapse(s) occurrence is a matter of discussion. We are describing herein the different therapeutic strategies proposed for maintenance and comment on future options for monitoring and treatments. (C) 2019 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.