A 60-year-old man presents with fever, weight loss, sinusitis, haemoptysis, and haematuria. ANCA testing shows c-ANCA (anti-PR3) positivity. Renal biopsy shows focal segmental necrotising glomerulonephritis with crescents and paucity of immune deposits. The induction therapy with the strongest evidence (RAVE and RITUXVAS trials) is:

• A Rituximab plus glucocorticoids ✓
• B Cyclophosphamide plus glucocorticoids
• C Methotrexate plus glucocorticoids
• D Mycophenolate mofetil plus glucocorticoids

Explanation

The RAVE trial demonstrated that rituximab was non-inferior to cyclophosphamide for induction of remission in ANCA-associated vasculitis (granulomatosis with polyangiitis), and was superior in relapsing disease. RITUXVAS similarly showed rituximab equivalence in severe renal disease. Rituximab plus glucocorticoids is now preferred particularly for new or relapsing severe GPA with anti-PR3 positivity. Cyclophosphamide remains an alternative.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.