ANCA Vasculitis Maintenance — ESENeph MCQ
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Correct answer: D — Individualise rituximab maintenance within 18 months to 4 years
The best answer is “Individualise rituximab maintenance within 18 months to 4 years”. KDIGO places maintenance after remission within an 18-month to 4-year range. Relapsing disease and PR3-ANCA increase relapse risk and support choosing toward the longer end after balancing infection, immunoglobulin and patient factors. “Stop maintenance at 6 months because induction response determines cure” is less appropriate because this is shorter than the KDIGO maintenance range and ignores the high relapse risk of relapsing PR3 disease “Continue maintenance until the ANCA test becomes negative” is less appropriate because serology alone does not define a universal stopping point “Continue maintenance for life in every patient” is less appropriate because KDIGO gives a finite range with individualisation rather than universal lifelong therapy “Use a fixed 12-month course for all AAV phenotypes” is less appropriate because this is below the stated range and ignores phenotype and prior-relapse risk
Reference: KDIGO 2024 ANCA-associated vasculitis guideline: https://kdigo.org/wp-content/uploads/2024/02/KDIGO-2024-ANCA-Vasculitis-Guideline.pdf