Determining the safest, best, and most effective therapeutic options for patients is crucial to improving outcomes and ensuring optimal health. As shared in a story from MD Edge, researchers recently sought to understand whether an induction therapy of rituximab (Rituxan) or cyclophosphamide (Cytoxan) was more effective at helping those with granulomatosis with polyangiitis (GPA) meet remission. The study eventually showed that rituximab induced remission at a higher rate than cyclophosphamide.

Evaluating the Research

Within the study, published in JAMA Open Network, researchers emulated a trial using data from 194 individuals with GPA who were treated over a 10-year period. A majority of patients were male, and a majority were also newly diagnosed. Additionally, 80.8% of patients were autoantibody positive (PR3-ANCA). The study found that:

• More patients had been treated with at least one cyclophosphamide dose than rituximab dose.
• Those taking cyclophosphamide were significantly more likely to have disease relapse than those taking rituximab.
• At six months, those taking rituximab were more likely to be in remission: 73.1% with rituximab and 40.1% with cyclophosphamide. Remission rates were similar in those who had been newly diagnosed or who had been grappling with GPA for a while.
• Those taking cyclophosphamide had more adverse reactions to treatment.

Ultimately, the researchers believe that rituximab is the best choice for a majority of patients with PR3-ANCA-positive GPA. However, they do recommend that each patient should speak with his or her care team to determine the best treatment course.

Granulomatosis with Polyangiitis (GPA): An Overview

Granulomatosis with polyangiitis is a rare disorder characterized by small and medium blood vessel inflammation (vasculitis) that can affect various organ systems in the body. As these blood vessels swell, blood flow is interrupted; cells are unable to be properly oxygenated. Currently, though the exact cause is still poorly understood, GPA is considered to be an autoimmune disease. It is most common in those between 40-60 years old, though it can occur outside of that range. The symptoms and signs of GPA vary between those affected. Potential symptoms can include:

• Frequent nosebleeds
• Nasal crusting, obstruction, or congestion
• Fever and night sweats
• Fatigue
• Decreased hearing
• Difficulty breathing
• Renal disease
• Skin rashes
• Sinus pain
• Appetite loss
• Unintended weight loss
• Coughing up blood
• Shortness of breath
• Joint pain
• Sinus, lung, kidney, ear, eye, skin, nerve, and/or joint damage
• Organ failure (complication)

Please note that this is not an exhaustive list of symptoms or signs.