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Cyclophosphamide toxicity — SCE Rheumatology MCQ

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HardRheumatological PharmacologyCyclophosphamide toxicitySCE Rheumatology

A 30-year-old with newly diagnosed organ-threatening GPA requires remission induction and wishes to preserve fertility. There is no contraindication to either standard induction agent. Which discussion best reflects current BSR recommendations?

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

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Correct answer: B — Offer rituximab as a fertility-sparing first-line induction option

Explanation lettering: C = shown as B · B = shown as C

C is correct. BSR recommends rituximab or intravenous cyclophosphamide for organ-threatening GPA/MPA; fertility and cumulative cyclophosphamide toxicity legitimately inform shared choice. A and B under-treat organ-threatening disease with less reliable induction strategies. D leaves active vasculitis without adequate disease-modifying induction. E reverses the guideline options and unnecessarily increases cumulative exposure.

Reference: BSR 2025 management recommendations for ANCA-associated vasculitis: https://academic.oup.com/rheumatology/article/64/8/4470/8160140