The edition · Rheumatology
Simple clinical scores helped predict relapse and serious infection after rituximab maintenance in ANCA vasculitis
Validation in the MAINRITSAN cohorts supports weighing both risks before extending rituximab beyond 18 months. Deucravacitinib improved psoriatic arthritis over placebo at 16 weeks, with safety data to 52, and PPI use in systemic sclerosis tracked disease severity more than benefit.
The edition in brief
In 217 patients from the MAINRITSAN 1 and 2 trials who received 18 months of rituximab maintenance for ANCA-associated vasculitis, 72-month relapse-free survival was 55% and one in five had a serious infection. An existing relapse model (male sex, age over 60, ANCA positivity, relapsing disease, ENT involvement, prednisone dose) predicted major relapse, mainly in PR3-ANCA disease, and an infection model (male sex, structural lung disease, diabetes, prior infections on maintenance, immunoglobulin level) identified patients with about three times the rate of serious infection. Together they can structure the conversation about extending rituximab. In the phase 3 POETYK PsA-1 trial of 670 biologic-naive patients, oral deucravacitinib 6 mg daily gave an ACR20 response in 54.2% vs 34.1% on placebo at 16 weeks, with low rates of serious adverse events through 52 weeks. In 10,660 EUSTAR systemic sclerosis patients, PPI use was associated with higher mortality, probably reflecting sicker patients, and with little effect on lung decline. A US cohort of 60,980 people with autoimmune rheumatic disease found booster or updated COVID-19 vaccination linked to about 70% lower odds of COVID hospitalisation than no vaccination. The pearl covers immunoglobulin checks on rituximab.
Deucravacitinib improved psoriatic arthritis over placebo, with low adverse event rates to 52 weeks
Deucravacitinib is an emerging oral option for psoriatic arthritis, but without head-to-head data it does not displace established therapies.
PPI use in systemic sclerosis tracked more severe disease, not better lungs
Use PPIs for reflux in systemic sclerosis, but do not expect them to slow lung disease.
Booster or updated COVID-19 vaccines were linked to fewer hospital admissions in rheumatic disease
Encourage patients with autoimmune rheumatic disease to keep COVID-19 vaccination up to date.
Check immunoglobulins before and during rituximab
Check immunoglobulins before and during rituximab and let falling IgG or recurrent infections prompt a review of continuation.
Relapse and infection scores may help decide whether to extend rituximab in ANCA vasculitis
Consider weighing validated relapse and infection risk factors together when deciding whether to extend rituximab beyond 18 months in ANCA vasculitis.
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