GPA Induction Therapy — RACP Adult Medicine MCQ
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Correct answer: B — Mycophenolate mofetil plus corticosteroids
For severe/organ-threatening ANCA-associated vasculitis (renal involvement, pulmonary haemorrhage), induction therapy consists of high-dose corticosteroids PLUS either rituximab or cyclophosphamide. The RAVE and RITUXVAS trials established rituximab as non-inferior (and possibly superior for relapsing disease) to cyclophosphamide for induction. Rituximab is increasingly preferred as first-line induction due to its more favourable long-term safety profile (less gonadotoxicity, less malignancy risk than cyclophosphamide). Plasma exchange may be added for severe renal disease (creatinine >500 µmol/L – PEXIVAS trial showed no benefit for less severe disease). Maintenance is with rituximab every 6 months (MAINRITSAN) or azathioprine.
Reference: eTG – 2025 – Rheumatology; KDIGO – 2024 – ANCA Vasculitis Guidelines