{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:46:42Z","timestamp":1792684002461,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"abstract":"\n Importance<\/jats:title>\n For patients with eosinophilic granulomatosis with polyangiitis (EGPA), guidelines recommend considering maintenance therapy after achieving remission. Data comparing maintenance therapeutic options are limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the effects of rituximab and azathioprine maintenance therapies on remission duration for patients with EGPA who recently achieved remission of vasculitis after standard therapy, including prednisone tapering or withdrawal.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n From March 7, 2018, to June 2, 2022, this double-blind, double-dummy, investigator-initiated, superiority, randomized clinical trial enrolled 98 participants with EGPA from 36 hospitals in France. Inclusion eligibility required a new EGPA diagnosis or relapsing EGPA within 30 to 360 days of achieving vasculitis remission (Birmingham Vasculitis Activity Score of 0 [range, 0-63, with higher scores indicating more severe disease activity]) after a standard induction regimen. Data were analyzed from April 1, 2025, to September 17, 2025. Additional analyses ended June 22, 2026.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomized to receive a predefined standardized tapering of oral prednisone and either 500 mg of intravenous rituximab every 6 months for 18 months and daily oral azathioprine placebo for 24 months (n\u2009=\u200949) or rituximab placebo every 6 months for 18 months and daily oral azathioprine for 24 months (n\u2009=\u200949).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary efficacy end point was the duration of total remission during the 28-month study period while taking 7.5 mg\/d or less of prednisone. The 14 secondary end points included proportion of participants remaining in remission, rate of vasculitis relapse, and rate of asthma or rhinosinusitis exacerbations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n All 98 randomized participants (mean age, 59.0 years [SD, 14.4]; 50 women [51%]) received at least 1 dose of the trial regimen and 92 (94%) completed the trial. The mean time in remission with prednisone at 7.5 mg\/d or less was 91.1 weeks (95% CI, 80.9-101.2) vs 96.0 weeks (95% CI, 85.6-106.5) in the rituximab and azathioprine groups, respectively (\n P<\/jats:italic>\n \u2009=\u2009.38). The proportion of participants who remained in remission during the 28-month study period with prednisone at 7.5 mg\/d or less was 17 of 49 (34.7%) vs 11 of 49 (22.4%; relative risk, 1.51; 95% CI, 0.83-2.73;\n P<\/jats:italic>\n \u2009=\u2009.18) in the rituximab and azathioprine groups, respectively. The proportion of participants with at least 1 vasculitis relapse was 7 (14.3%) vs 9 (18.4%) in the rituximab vs azathioprine groups, respectively, and for those with at least 1 clinically significant asthma exacerbation, rhinosinusitis exacerbation, or both, it was 16 (32.7%) vs 19 (38.8%). One participant in the azathioprine group died of SARS-CoV-2 infection before vaccine development. Rituximab recipients experienced a higher incidence of severe infections (23 [46.9%] vs 12 [24.5%], respectively), primarily due to severe SARS-CoV-2 infections.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n For participants with newly diagnosed or relapsing EGPA, rituximab was not superior to azathioprine for improving the duration of total remission during 28 months while taking prednisone at 7.5 mg\/d or less.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03164473<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.15278","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:30:42Z","timestamp":1792683042000},"source":"Crossref","is-referenced-by-count":0,"title":["Rituximab vs Azathioprine for Eosinophilic Granulomatosis With Polyangiitis Maintenance Therapy"],"prefix":"10.1001","author":[{"given":"Xavier","family":"Pu\u00e9chal","sequence":"first","affiliation":[{"name":"National Referral Center for Rare Systemic Autoimmune Diseases, H\u00f4pital Cochin, Assistance Publique\u2013H\u00f4pitaux de Paris, Paris, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9gory","family":"Pugnet","sequence":"additional","affiliation":[{"name":"INSERM UMR1027, Toulouse, France"},{"name":"Department of Internal Medicine and Clinical Immunology, Centre Hospitalier Universitaire Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Thoreau","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Immunology, Centre Hospitalier Universitaire Tours, Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"de Moreuil","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centre Hospitalier Universitaire La Cavale Blanche, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Jouneau","sequence":"additional","affiliation":[{"name":"Reference Center for Rare Pulmonary Diseases, Centre Hospitalier Universitaire Pontchaillou, Universit\u00e9 de Rennes, Rennes, France"},{"name":"Inserm, EHESP, Irset (Institut de recherche en sant\u00e9, environnement et travail)\u2013UMR_S 1085, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Qu\u00e9m\u00e9neur","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Internal Medicine, CH, Valenciennes, France"},{"name":"Rheumatology and Internal Medicine Department, Saint Philibert Hospital, Hospital Network of the Catholic University of Lille, Lille, 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