skip to main content

AAV Maintenance Therapy — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNephrologyAAV Maintenance TherapyRACP Adult Medicine

A 65-year-old man with newly diagnosed ANCA-associated vasculitis (MPA, MPO-ANCA positive) with pulmonary-renal syndrome (crescentic GN and alveolar haemorrhage) receives induction therapy with rituximab plus corticosteroids. What maintenance therapy should follow?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — No maintenance needed after rituximab induction

Following induction with rituximab (or cyclophosphamide), maintenance therapy with rituximab 500 mg IV every 6 months is recommended for at least 2 years (MAINRITSAN trial showed superiority of rituximab over azathioprine for maintenance). Azathioprine is an alternative if rituximab is not available. The optimal duration of maintenance is uncertain but most guidelines recommend ≥2 years, with individualised decisions about cessation based on ANCA levels, clinical stability, and relapse risk. PR3-ANCA positive patients have higher relapse risk than MPO-ANCA positive patients.

Reference: KDIGO – 2024 – ANCA Vasculitis Guidelines; MAINRITSAN Trial