Alesaeidi Samira, Radnia Masoud, Tavakolpour Soheil, Jazayeri Seyed Behnam, Loni Shima
Department of Internal Medicine and Rheumatology, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Caspian J Intern Med. 2025 Jun 23;16(3):480-486. doi: 10.22088/cjim.16.3.480. eCollection 2025 Summer.
Granulomatosis with polyangiitis (GPA) is a rare disease affecting medium-small vessels, causing granuloma formation and inflammation. This study aimed to assess the efficacy and safety of RTX versus Azathioprine (AZA) for maintenance treatment in GPA patients.
This retrospective cohort study involved a review of medical records of recently diagnosed GPA patients undergoing maintenance treatment with RTX or AZA. The main variable was the frequency of relapses within an 18-month follow-up period. Additionally, the study compared changes in BVAS.WG score (The Birmingham Vasculitis Activity Score-Wegner specific) and Damage (vasculitis damage index (VDI)), mortality, and treatment complications between the two groups.
Among the 43 patients receiving RTX maintenance treatment, 8 (18.6%) experienced relapses during 24 months follow-up, while 14 (66.6%) out of the 21 patients receiving AZA relapsed (Hazard Ratio = 6.9 and 95% confidence interval = 1.95-19.3, p <001). Notably, the increase in the BVAS-WG score was significantly lower in the RTX group compared to the AZA group (p <001). The cumulative steroid dose was 143±21 mg in the RTX group and 125±25 mg in the AZA group (P = 0.1). Treatment side effects were similar in both groups (p >0.05).
Maintenance treatment with RTX is associated with better treatment response and lower relapse rate compared to AZA. There was no difference in treatment complications between AZA or RTX in maintenance treatment.
肉芽肿性多血管炎（GPA）是一种罕见疾病，累及中小血管，可导致肉芽肿形成和炎症。本研究旨在评估利妥昔单抗（RTX）与硫唑嘌呤（AZA）对GPA患者维持治疗的疗效和安全性。
这项回顾性队列研究包括对近期诊断为GPA且正在接受RTX或AZA维持治疗的患者的病历进行回顾。主要变量是18个月随访期内的复发频率。此外，该研究比较了两组之间伯明翰血管炎活动评分-韦格纳特异性（BVAS.WG评分）、损伤（血管炎损伤指数（VDI））、死亡率和治疗并发症的变化。
在接受RTX维持治疗的43例患者中，8例（18.6%）在24个月随访期间复发，而在接受AZA治疗的21例患者中，14例（66.6%）复发（风险比=6.9，95%置信区间=1.95-19.3，p<0.01）。值得注意的是，RTX组的BVAS-WG评分升高显著低于AZA组（p<0.01）。RTX组的累积类固醇剂量为143±21mg，AZA组为125±25mg（P=0.1）。两组的治疗副作用相似（p>0.05）。
与AZA相比，RTX维持治疗具有更好的治疗反应和更低的复发率。在维持治疗中，AZA和RTX的治疗并发症没有差异。
