Comparison of Rituximab and Cyclophosphamide for Induction Therapy in Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Systematic Review of Randomized Trials and Comparative Cohort Evidence

This systematic review examines the comparative effectiveness of rituximab and cyclophosphamide for remission induction in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, synthesizing findings from high-quality randomized trials and real-world cohort studies. The available evidence consistently shows that rituximab achieves remission rates comparable to cyclophosphamide in newly diagnosed disease and offers clear advantages in relapsing vasculitis. In patients with organ-threatening disease, including severe renal involvement, both treatments demonstrate similar efficacy, although rituximab provides a more targeted immunologic approach and avoids the cumulative toxicity associated with cyclophosphamide. Long-term follow-up data indicate that remission durability with rituximab is maintained when appropriate maintenance strategies are applied. Observational studies further support rituximab's effectiveness in routine clinical practice, particularly in PR3-ANCA vasculitis and in individuals requiring steroid-sparing regimens. Overall, this review highlights rituximab as a strong and often preferable induction option, offering effective disease control with a more favorable long-term safety profile. These findings reinforce the evolving role of rituximab as a central component of modern therapeutic strategies for ANCA-associated vasculitis.