Do you recommend on-demand versus fixed-schedule dosing for rituximab maintenance in ANCA vasculitis?

This is a fairly hot question in the field, and one that reflects the success we have had with advancing therapy for ANCA-associated vasculitis; it’s nice to have choices!

Although there are data for both approaches, there are more data (larger numbers, etc.), in my opinion, for fixed-dosing. The trend is towards less and less total annual rituximab dosing; however, the benefits of “less” are empiric and logical but not proven and would require large sample sizes to see differences in adverse ev...

This is a great question and one that does not have a definitive right answer. However, there is significant data in this area:

- Longer maintenance of remission (with RTX or other agents) reduces flares (REMAIN, Terrier et al., PMID 29724729).

- Patients with absent B-cells flare at much lower rates (RAVE). Important to keep in mind that flares can certainly still happen with undetectable B-cells.

- "Tailored" rituximab dosing (when B-cells become detectable or there is an ANCA rise) is equivalent...