Long-term disease control in granulomatosis with polyangiitis: Is low-dose rituximab the cure?

This study corroborates the role of RTX combined with GCs for induction and maintenance therapy of GPA. The effectiveness and safety of this treatment were satisfactory in the examined cohort and have been evaluated over a long-term follow-up in a significant proportion of patients with pre-existing comorbidities. Low-dose pre-emptive RTX seems to succeed in maintaining remission even in relapsing PR3-ANCA+ patients with granulomatous dis- ease, considered the most difficult-to-treat group. These results need to be carefully compared with those of the RITAZAREM trial to further understand the risks and bene- fits of low-dose vs high-dose RTX in the long term. Appropriate use of RTX probably depends on several fac- tors, such as disease phenotype, history of relapse, patient characteristics and previous treatments. To assess these points, careful stratification of patients is essential, and so is the development of biomarkers able to predict relapse more reliably than the ones currently used (e.g. ANCA titre modifications, B cell reconstitution). Cohort studies will go on to confirm, anticipate and complete RCT results, offering new perspectives for optimal disease treatment.