Background/Purpose: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), including Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA), often manifests with life-threatening complications. Cyclophosphamide (CYC) and rituximab (RTX) are the mainstay of remission induction treatment in severe AAV, but their safety and efficacy have not been comprehensively compared in “real-world” settings.

Methods: We conducted a retrospective cohort study using administrative data from the

2006–2019 IBM® MarketScan® Commercial Database. We identified working-age adults (age 18-64 years) with a new diagnosis of GPA/MPA, using the International Classification of Diseases (ICD) version 9 or 10 codes, who received induction treatment with CYC or RTX. We used propensity score matching and a Cox proportional hazard model to estimate hazard ratios (HRs) for the first major disease relapse and severe infection.

Results: We identified 657 patients, 406 (61.8%) of whom were treated with CYC and 251 (38.2%) with RTX. Patients in the CYC group had worse disease severity scores at baseline.

In the 24 months after induction, 146 (22.2%) patients experienced a major disease relapse and 129 patients (19.6%) had severe infection. Multivariate analysis with propensity score matching showed no significant differences between RTX and CYC in the likelihood of experiencing major relapse (HR 0.57, 95% CI 0.32-1.01) or severe infection (HR 0.63, 95% CI 0.30-1.02).

Conclusion: In a nationally representative sample of working-age adults, RTX was found to be comparable to CYC for remission induction treatment in severe AAV.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-outcomes-for-remission-induction-in-working-age-adults-with-severe-anti-neutrophil-cytoplasmic-antibody-associated-vasculitis/