---
title: "Outcomes After Relapse During Rituximab Maintenance in ANCA-Associated Vasculitis — Single-Center"
id: "pubmed-42743142"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42743142"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42743142/"
doi: "10.1371/journal.pone.0357836"
published_at: "2026-09-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Outcomes After Relapse During Rituximab Maintenance in ANCA-Associated Vasculitis — Single-Center
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42743142
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42743142/)
- **DOI:** [10.1371/journal.pone.0357836](https://doi.org/10.1371%2Fjournal.pone.0357836)
- **Published At:** 2026-09-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This single-center retrospective cohort examined 17 patients with **ANCA-associated vasculitis (AAV)** who experienced a first relapse while receiving **rituximab (RTX)**-based maintenance after remission induction. The study compared outcomes according to whether **mycophenolate mofetil (MMF)** was added to the initial post-relapse treatment. - Patients were grouped as MMF-added (n = 9) or MMF-not-added (n = 8). Median age across the cohort was 76 years; 94.1% were MPO-ANCA positive. - In the MMF-added group, MMF was started at a median of 0.4 months after relapse (IQR 0.3–0.4; range 0.3–0.5 months). - All patients achieved remission after intensifying post-relapse therapy in both groups. - During a median follow-up of 28 months (IQR 21–33), no second relapses occurred in the MMF-added group, while three second relapses occurred in the MMF-not-added group. - All nine patients in the MMF-added group were able to discontinue glucocorticoids; all eight patients managed without MMF continued glucocorticoids during follow-up. - Severe infections requiring hospitalization occurred in three patients in the MMF-not-added group and in none of the MMF-added group. - Treatment allocation was non-randomized and post-relapse regimens differed by RTX scheduling, concomitant therapies, and physician-directed glucocorticoid tapering, so the independent effect of **MMF** could not be established. - Authors conclude these descriptive, hypothesis-generating findings require confirmation in prospective studies.
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Affiliations Expand ### Affiliations * 1 Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan. * 2 Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, Okazaki, Aichi, Japan. * 3 Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan. * PMID: **42743142** * DOI: [ 10.1371/journal.pone.0357836 ](https://doi.org/10.1371/journal.pone.0357836) Item in Clipboard # Clinical outcomes after relapse during rituximab-based maintenance in ANCA-associated vasculitis: A single-center retrospective cohort study Makoto Yamaguchi et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) . 2026 Sep 15;21(9):e0357836. doi: 10.1371/journal.pone.0357836. eCollection 2026. ### Authors [Makoto Yamaguchi](https://pubmed.ncbi.nlm.nih.gov/?term=Yamaguchi+M&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Hirokazu Sugiyama](https://pubmed.ncbi.nlm.nih.gov/?term=Sugiyama+H&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Hiroshi Kinashi](https://pubmed.ncbi.nlm.nih.gov/?term=Kinashi+H&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Keisuke Kamiya](https://pubmed.ncbi.nlm.nih.gov/?term=Kamiya+K&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Genri Tagami](https://pubmed.ncbi.nlm.nih.gov/?term=Tagami+G&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Masayoshi Toda](https://pubmed.ncbi.nlm.nih.gov/?term=Toda+M&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Takayuki Katsuno](https://pubmed.ncbi.nlm.nih.gov/?term=Katsuno+T&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-2 "Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, Okazaki, Aichi, Japan."), [Takahiro Imaizumi](https://pubmed.ncbi.nlm.nih.gov/?term=Imaizumi+T&cauthor_id=42743142)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-3 "Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan."), [Shogo Banno](https://pubmed.ncbi.nlm.nih.gov/?term=Banno+S&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Yasuhiko Ito](https://pubmed.ncbi.nlm.nih.gov/?term=Ito+Y&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan."), [Takuji Ishimoto](https://pubmed.ncbi.nlm.nih.gov/?term=Ishimoto+T&cauthor_id=42743142)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42743142/#short-view-affiliation-1 "Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan.") ### Affiliations * 1 Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan. * 2 Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, Okazaki, Aichi, Japan. * 3 Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan. * PMID: **42743142** * DOI: [ 10.1371/journal.pone.0357836 ](https://doi.org/10.1371/journal.pone.0357836) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Relapse during rituximab (RTX)-based maintenance therapy remains a clinical problem in ANCA-associated vasculitis (AAV). Mycophenolate mofetil (MMF) has been investigated as an alternative; however, evidence regarding its use after relapse during RTX-based maintenance is limited. We aimed to retrospectively describe clinical outcomes in patients with AAV who relapsed during RTX-based maintenance according to whether MMF was included in the initial post-relapse treatment strategy. We retrospectively analyzed 17 patients with AAV who experienced their first relapse during RTX-based maintenance after remission induction. Baseline was defined as the time of the first relapse. Post-relapse treatment included glucocorticoid escalation and/or RTX re-administration; patients were categorized according to whether MMF was additionally included in the initial treatment strategy (MMF-added group, n = 9; MMF-not-added group, n = 8). All outcomes were evaluated descriptively. In the MMF-added group, MMF was initiated at a median of 0.4 months after the first relapse (interquartile range [IQR], 0.3-0.4 months; range, 0.3-0.5 months). The median age was 76 years (IQR, 73-81 years); 16 patients (94.1%) were MPO-ANCA-positive. During a median follow-up of 28 months (IQR, 21-33 months), all patients achieved remission after post-relapse treatment intensification. No second relapse occurred in the MMF-added group, whereas three patients in the MMF-not-added group experienced a second relapse. Glucocorticoids were discontinued in all nine patients in the MMF-added group, whereas in the MMF-not-added group, all eight patients continued glucocorticoids while they were managed without MMF. Severe infections requiring hospitalization occurred in none of the patients in the MMF-added group and in three patients in the MMF-not-added group. Because treatment allocation was non-randomized and post-relapse treatment strategies differed with respect to RTX scheduling, concomitant therapies, and physician-directed glucocorticoid tapering, the independent effect of MMF could not be determined. Therefore, these descriptive and hypothesis-generating findings warrant confirmation in future prospective studies. Copyright: © 2026 Yamaguchi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement The authors have declared that no competing interests exist. ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Aged, 80 and over Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%2C+80+and+over%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged%2C+80+and+over) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anti-Neutrophil+Cytoplasmic+Antibody-Associated+Vasculitis%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anti-Neutrophil+Cytoplasmic+Antibody-Associated+Vasculitis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Anti-Neutrophil+Cytoplasmic+Antibody-Associated+Vasculitis%2Fpathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Anti-Neutrophil+Cytoplasmic+Antibody-Associated+Vasculitis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Immunosuppressive Agents / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Immunosuppressive+Agents%2Ftherapeutic+use%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Immunosuppressive+Agents) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Male Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Male%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Male) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Mycophenolic Acid / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Mycophenolic+Acid%2Ftherapeutic+use%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Mycophenolic+Acid) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Recurrence Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Recurrence%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Recurrence) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42743142/) * Remission Induction Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Remission+Induction%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Remission+Induction) * [ Add
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