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At the time RAVE study was designed, not giving CYC (standard of care then) was a big deal so the sickest patients were excluded #rheumjc

Great question Paul. No great answer about RTX and pheresis. We try to give RTX right after pheresis and not pherese next few days #rheumjc

Elana - Severe RPGN nearing dialsysi is where some, esp nephrologists, still use CYC. Many though use RTX alone w/anecdotal success #rheumjc

EGPA vasculitis - small case series. Overall belief is it works for vasculitic manifestations, but not great for eosinophilic stuff #rheumjc

Agree w/Paul - RAVE was lymphoma dosing for all pts. Some data to suggest 2 dose vs 4 dose depletes periph B-cells similarly #rheumjc

RA protocol vs lymphoma protocol in AAV never studied formally to my knowledge #rheumjc

Minor point re:DAH. Pts in RAVE had DAH. Excluded only if were intubated. #rheumjc

Another unanswered question is onset of action RTX vs CYC. No data to suggest CYC acts faster, but difficult to answer. #rheumjc

Yes - recent MAINRITSAN trial showed RTX better for prevention of relapses (500mg q6mos) than azathioprine. #rheumjc

We use maintenance RTX in some patients. Do others? #rheumjc

However, B-cell return or even ANCA rise does not accurately predict future relapse #rheumjc

Experts vary in whether we check B-cells before retreating #rheumjc

Personally. If flare, then I don't care if B-cells absent, I'd still treat #rheumjc

If using it for maintenance, there is some rationale for waiting for b-cell return. Currently ongoing MAINRITSAN2 will address this #rheumjc

I still use CYC, but wondering if it'll hold up for where there's no great data for alternative: severe ILD, EGPA, CNS vasculitis #rheumjc

@zandbelt 12 patients - makes sense b/c if they failed RTX hard to give RTX again in a study #rheumjc

@zandbelt I don't think we included that. The detailed six month outcomes are at Arthritis Rheum. 2013 Sep;65(9):2441-9 #rheumjc

@zandbelt in 1st 6 months after CYC 9 severe and 14 non-severe relapses. after RTX 3 severe and 11 non-severe. No statistical diff #rheumjc

Thanks for having me. Great discussion! #rheumjc

@zandbelt Article we'll soon submit demonstrates RTX may be better in PR3 disease than CYC. Also seems better in relapsed disease#rheumjc