Anti-neutrophil cytoplasmic antibody (
ANCA)-associated vasculitis (AAV) is systemic vascular
inflammation.
Microscopic polyangiitis (MPA) is a major type of AAV in Japan. MPA often affects the kidneys and lungs, leading to death if untreated. Induction
therapy (i.e., initial treatment) for MPA has not been optimized, although
methylprednisolone and
cyclophosphamide are commonly used. Recently,
rituximab (RTX) (a
monoclonal antibody against the
protein CD20) has also been used to treat refractory AAV. RTX at 375 mg/m2/week for 4 weeks (i.e., the conventional
lymphoma dosing schedule) is used, but the optimal dosing schedule is controversial. Indeed, a single-dose of RTX successfully controlled
nephrotic syndrome. However, to date, the effectiveness of a single RTX dose in treating MPA has not been fully investigated in Japan. This was a retrospective observational study. Six newly diagnosed patients with MPA were initially treated with
methylprednisolone and a single dose of RTX (375 mg/m2). We investigated the patients' clinical features, as well as the efficacy and safety of RTX treatment. All patients attained remission on a tapered
prednisolone dose of < 10 mg/day during the first 12 months. One patient relapsed after 12 months whereas another required hospitalization owing to infective spondyloarthritis. Adverse reactions to RTX infusion and late-onset
neutropenia were not observed. Therefore, a single-dose treatment with RTX induced remission with few complications, and allowed tapering the
prednisolone treatment. We conclude that a single dose of RTX is a promising induction
therapy for MPA, reducing the cost associated with multiple doses.