{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:03:54Z","timestamp":1789495434791,"version":"build-2803163510"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Relapse during rituximab (RTX)-based maintenance therapy remains a clinical problem in ANCA-associated vasculitis (AAV). Mycophenolate mofetil (MMF) has been investigated as an alternative; however, evidence regarding its use after relapse during RTX-based maintenance is limited. We aimed to retrospectively describe clinical outcomes in patients with AAV who relapsed during RTX-based maintenance according to whether MMF was included in the initial post-relapse treatment strategy. We retrospectively analyzed 17 patients with AAV who experienced their first relapse during RTX-based maintenance after remission induction. Baseline was defined as the time of the first relapse. Post-relapse treatment included glucocorticoid escalation and\/or RTX re-administration; patients were categorized according to whether MMF was additionally included in the initial treatment strategy (MMF-added group, n\u2009=\u20099; MMF-not-added group, n\u2009=\u20098). All outcomes were evaluated descriptively. In the MMF-added group, MMF was initiated at a median of 0.4 months after the first relapse (interquartile range [IQR], 0.3\u20130.4 months; range, 0.3\u20130.5 months). The median age was 76 years (IQR, 73\u201381 years); 16 patients (94.1%) were MPO-ANCA-positive. During a median follow-up of 28 months (IQR, 21\u201333 months), all patients achieved remission after post-relapse treatment intensification. No second relapse occurred in the MMF-added group, whereas three patients in the MMF-not-added group experienced a second relapse. Glucocorticoids were discontinued in all nine patients in the MMF-added group, whereas in the MMF-not-added group, all eight patients continued glucocorticoids while they were managed without MMF. Severe infections requiring hospitalization occurred in none of the patients in the MMF-added group and in three patients in the MMF-not-added group. Because treatment allocation was non-randomized and post-relapse treatment strategies differed with respect to RTX scheduling, concomitant therapies, and physician-directed glucocorticoid tapering, the independent effect of MMF could not be determined. Therefore, these descriptive and hypothesis-generating findings warrant confirmation in future prospective studies.<\/jats:p>","DOI":"10.1371\/journal.pone.0357836","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:23:03Z","timestamp":1789492983000},"page":"e0357836","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes after relapse during rituximab-based maintenance in ANCA-associated vasculitis: A single-center retrospective cohort study"],"prefix":"10.1371","volume":"21","author":[{"given":"Makoto","family":"Yamaguchi","sequence":"first","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kinashi","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genri","family":"Tagami","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Toda","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Katsuno","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]},{"name":"Aichi Medical University Medical Center","place":["Okazaki, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Imaizumi","sequence":"additional","affiliation":[{"name":"Nagoya University Hospital","place":["Nagoya, Japan"],"department":["Data Coordinating Center, Department of Advanced Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shogo","family":"Banno","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiko","family":"Ito","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9861-5331","authenticated-orcid":true,"given":"Takuji","family":"Ishimoto","sequence":"additional","affiliation":[{"name":"Aichi Medical University","place":["Nagakute, Aichi, Japan"],"department":["Department of Nephrology and Rheumatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"issue":"9","key":"pone.0357836.ref001","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1136\/annrheumdis-2016-209133","article-title":"EULAR\/ERA-EDTA recommendations for the management of ANCA-associated vasculitis","volume":"75","author":"M Yates","year":"2016","journal-title":"Ann Rheum Dis"},{"issue":"8","key":"pone.0357836.ref002","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1136\/annrheumdis-2017-212878","article-title":"Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2)","volume":"77","author":"P Charles","year":"2018","journal-title":"Ann Rheum 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