Predicting relapse and infection to optimize patient outcomes in ANCA-associated vasculitis: data from the MAINRITSAN trials cohort
OBJECTIVES: Long-term follow-up of the MAINRITSAN trials confirmed the efficacy of rituximab (RTX) in preventing relapses in ANCA-associated vasculitis (AAV). Extending RTX maintenance beyond 18 months may benefit high-risk patients. The aim of this study was to validate relapse and infection prediction models to guide individualized RTX extension decisions. METHODS: Data from 217 patients in the MAINRITSAN1 and MAINRITSAN2 trials treated with RTX for 18 months with follow-up through December 2020 were analyzed. We externally validated relapse and infection prediction models from McClure et al. Primary endpoints were relapse-free survival and serious infection-free survival. RESULTS: Relapse occurred in 76 patients, with a 72-month relapse-free survival rate of 55% (95% CI 48-64). Serious infections occurred in 33 patients, with a cumulative 72-month incidence of 20%. The relapse model (factors: male sex, age > 60 years, ANCA positivity, relapsing disease, ENT involvement, prednisone dose) predicted major relapse (coefficient 1.34, p = 0.04) and identified high-risk patients with shorter major relapse-free survival (HR 1.91, 95% CI 0.97-3.76, p = 0.059). The relapse score was associated with major relapse risk predominantly within the PR3-ANCA subgroup (coefficient 2.76, p = 0.01). The infection model (factors: male sex, structural lung disease, diabetes, occurrence of infections during maintenance therapy, and gammaglobulin level) identified high-risk patients with shorter serious infection-free survival (HR 2.93, 95% CI 1.28-6.72, p = 0.011). CONCLUSION: The relapse prediction model demonstrated reproducible performance in this external validation cohort and may contribute to clinically relevant risk stratification, especially in PR3-ANCA patients. The infection model showed stronger predictive performance and may support individualized discussions regarding RTX extension.
Authors
- I de Lacroix-Szmania
- Xavier Delbrel
- D. Sène (ORCID: https://orcid.org/0000-0001-8640-4580)
- Romain Paule (ORCID: https://orcid.org/0000-0003-4360-4157)
- NADINE MÉAUX-RUAULT
- Christine Vinter
- F. Grassin
- Serge Perrot (ORCID: https://orcid.org/0000-0002-0509-1592)
- Thomas Le Gallou
- Marie Frimat (ORCID: https://orcid.org/0000-0002-7461-8298)
- Florence Delestre (ORCID: https://orcid.org/0000-0001-8263-1321)
- Anne-Bérangère Beucher
- Pierre Charles
- Bertrand Dunogué (ORCID: https://orcid.org/0000-0003-2470-6166)
- D. Bagnères
- G. Gondran (ORCID: https://orcid.org/0000-0003-2588-8109)
- Bernard Gilson
- Sophie Rivière
- N. M. Silva
- Ursula Warzocha
- Alain Ramassamy
- Marc Fabre
- Stéphanie Mestrallet (ORCID: https://orcid.org/0009-0007-6427-6128)
- B. Brihaye (ORCID: https://orcid.org/0000-0002-8195-6324)
- Catherine Hanrotel‐Saliou
- N. Schleinitz (ORCID: https://orcid.org/0000-0001-9449-3392)
- Sébastien Canet
- Stanislas Faguer (ORCID: https://orcid.org/0000-0003-0553-0927)
- H. Kassem
- Christian Delafosse
- Richard Damade (ORCID: https://orcid.org/0000-0003-4727-5282)
- Olivier Lidove (ORCID: https://orcid.org/0000-0003-4847-7839)
- X. Kyndt
- Guillaume Leveiller
- L Wemeau (ORCID: https://orcid.org/0000-0003-4962-6680)
- Helder Gil
- Isabelle Guichard (ORCID: https://orcid.org/0000-0003-1573-7171)
- Sébastien Delbès
- Pascal Godmer
- Edouard Bégon (ORCID: https://orcid.org/0000-0001-6112-0549)
- Claire Rigothier (ORCID: https://orcid.org/0000-0002-5569-5562)
- Roderich Meckenstock
- N. Tieulié
- Constance Guillaud
- Simona Pavel
- L. Lahaxe
- Nolwenn Rabot
- Audrey Sultan
- Vincent Poindron
- Stephane Vinzio
- Alexandre Karras
- N. Antoine
- Anthony Bonnin
- Nathalie Lerolle
- Robin Dhôte (ORCID: https://orcid.org/0000-0001-9969-9947)
- Claire Blanchard‐Delaunay
- Raphaele Seror
- Jean-Benoit Arlet
- Jean-Francois Viallard
- Raphael Porcher
- the French Vasculitis Study Group (FVSG)
- Mathias Buchler
- Thomas Quéméneur
- Marie Lino-Daniel
- Grégory Pugnet
- Alexis Régent
- Christian Agard
- Olivier Fain
- Abdeldjallil Koreichi
- Jean-Michel Galempoix
- Cécile-Audrey Durel
- François Maurier
- Claire de Moreuil
- Loïc Guillevin
- Xavier Puéchal
- Thomas Papo
- François Lifermann
- Luc Mouthon
- Eric Hachulla
- Aurélie Schiffman
- Hélène Francois
- Julien Allard
- Ali Boumallassa
- Maxime Samson
- Mathilde de Menthon
- Laurent Perard
- Mathieu Puyade
- Frédéric Bocquentin
- Benjamin Terrier
Institutions
- Inserm (FR)
- Université Paris Cité (FR)
- Université de Lille (FR)
- Centre Hospitalier Universitaire de Lille (FR)
- Centre Hospitalier Universitaire de Nantes (FR)
- Centre Hospitalier Universitaire de Toulouse (FR)
- Centre Hospitalier Universitaire de Besançon (FR)
- Sorbonne Paris Cité (FR)
- Institute Mutualiste Montsouris (FR)
- Hôpital Cochin (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Hôpital Européen Georges-Pompidou (FR)
- Centre hospitalier Bretagne Atlantique (FR)
- Centre Hospitalier Universitaire de Caen Normandie (FR)
- CHU Dijon Bourgogne (FR)
- Metabolism and Renal Physiology (FR)
- Centre Hospitalier Régional Universitaire de Brest (FR)
- Hôtel-Dieu de Paris (FR)
- Centre Hospitalier de Dax –Côte d’Argent (FR)
- Centre Hospitalier Universitaire de Rennes (FR)
- Centre Hospitalier de Valenciennes (FR)
- Institute for Translational Research in Inflammation (FR)
- Centre de Recherche Épidémiologie et Statistique (FR)
Publication Details
- Journal
- Lara D. Veeken
- Published
- 2026-09-27
- DOI
- https://doi.org/10.1093/rheumatology/keag542
- Primary Topic
- Vasculitis and related conditions
- Type
- article
- Field-Weighted Citation Impact
- 0.00