TOPLINE:

Rituximab treatment vs cyclophosphamide treatment in adult patients with immunoglobulin A vasculitis (IgAV) was associated with lower risks for renal complications, such as end-stage renal disease and dialysis dependence.

METHODOLOGY:

• Researchers conducted an emulated trial using data from 76 healthcare organizations through the TriNetX database between 2017 and 2025.
• A cohort of 1190 adults with IgAV and glomerular disease was identified using diagnostic codes and algorithms.
• Patients received either rituximab or cyclophosphamide within 1 year of diagnosis, with intention-to-treat analysis based on the initial treatment assignment.
• Propensity score matching was performed to balance treatment groups on demographics, comorbidities, laboratory data, and medication use, resulting in the inclusion of 368 patients who received rituximab (mean age, 50.2 years; 50.8% female; 66.6% White) and 368 patients who received cyclophosphamide (mean age, 49.6 years; 54.6% female; 67.1% White).
• The primary outcomes were the 5-year incidences of end-stage renal disease, dialysis dependence, kidney transplant, and stage III-V chronic kidney disease, with varicose vein and trauma diagnoses as negative controls.

TAKEAWAY:

• Patients treated with rituximab vs cyclophosphamide had lower risks for end-stage renal disease (hazard ratio [HR], 0.65; 95% CI, 0.45-0.93) and dialysis dependence (HR, 0.66; 95% CI, 0.45-0.97).
• Patients receiving rituximab had lower risks for kidney transplant (HR, 0.50; 95% CI, 0.29-0.87) and stage III-V chronic kidney disease (HR, 0.65; 95% CI, 0.49-0.88) than those receiving cyclophosphamide.
• No significant differences were found in the risk for myocardial infarction, stroke, or venous thromboembolism between the two treatment groups.
• No increased risks for the negative control outcomes were observed.

IN PRACTICE:

“In the context of scarce high-quality evidence, these findings offer novel real-world evidence to inform therapeutic decision-making in adult patients with IgAV and renal involvement,” the authors of the study wrote.

SOURCE:

The study was led by Arjun Mahajan, MS, Harvard Medical School, Boston. It was reported online on January 12, 2026, in a letter to the editor published in Arthritis & Rheumatology.

LIMITATIONS:

Risk stratification between skin-limited and renal-involved disease was not possible. Data on medication dosing and exposure were lacking. Combination therapy could not be evaluated due to limited sample size.

DISCLOSURES:

One author reported receiving support from the Rheumatology Research Foundation Future Physician Scientist Award. Another author reported receiving support from grants by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; the National Heart, Lung, and Blood Institute; and other sources, as well as receiving research support from and performing consultancy for various pharmaceutical and therapeutic companies including Boehringer Ingelheim, Bristol Myers Squibb, and AbbVie unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.