{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:34:12Z","timestamp":1761284052821,"version":"build-2065373602"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Patients with ulcerative colitis (UC) and PR3-ANCA positivity often show a poor response to infliximab (IFX). Our objective was to compare the effectiveness and safety of rituximab (RTX) and IFX in moderately-to-severely active PR3-ANCA positive (PR3-ANCA+) UC patients. This study represents the first exploration of biomarker-guided therapy (PR3-ANCA+) in moderately-severely active UC, aiming to generate hypothesis-driven evidence for future randomized trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, multicenter, real-world study focused on a rare biomarker-defined subgroup (PR3-ANCA + UC) and was conducted across three medical centers in Hubei, China. Moderately to severely active UC patients with PR3-ANCA+ were assigned to the RTX group (n = 12) and the IFX group (n = 26) based on biological therapy received. Endpoints at week 22 included clinical remission (primary), clinical response, endoscopic response, improvement, and remission. Safety endpoints centered on opportunistic infections and drug-related adverse events. Inverse probability of treatment weighting (IPTW) and multifactorial logistic regression analysis (MLRS) were used to reduce confounding effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pre-IPTW, compared with IFX, RTX significantly increased the rates of clinical remission, clinical response, endoscopic response, endoscopic improvement, and endoscopic remission by 60.25% (95%CI: 33.68%\u201386.82%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), 34.62% (95%CI: 16.33%\u201352.91%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.020), 65.38% (95%CI: 45.15%\u201385.61%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), 38.46% (95%CI: 10.65%\u201366.27%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.010), and 65.38% (95%CI: 45.15%\u201385.61%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), respectively. After IPTW, RTX remained associated with significantly higher rates of the above outcomes versus IFX, with increases of 53.68% (95%CI: 35.26%\u201372.10%, P = 0.012), 33.90% (95%CI: 16.52%\u201351.28%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002), 62.71% (95%CI: 46.35%\u201379.07%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), 46.61% (95%CI: 26.83%\u201366.39%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.024), and 62.71% (95%CI: 46.35%\u201379.07%,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), respectively. In MLRS, RTX was associated with higher odds of week-22 clinical remission compared with IFX, with consistent results before and after IPTW [pre-IPTW: OR = 31.022 (2.911\u2013970.983),\n                      <jats:italic>P<\/jats:italic>\n                      = 0.010; post-IPTW: OR = 47.692 (4.077\u20131,418.298),\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007]. Additionally, for every 50% reduction in PR3-ANCA levels, the odds ratio (OR) for clinical remission was 7.583 (95%CI: 1.648\u201334.903). Furthermore, this conclusion remained robust after adjusting for confounding factors. For safety endpoints, no RTX patients had elevated tuberculosis interferon tests, while 2 IFX patients (7.69%) did. In addition, no HBV reactivation or infection occurred in either group. Mean IgG levels remained stable in RTX-treated patients (11.50 \u00b1 3.59 vs. 10.84 \u00b1 1.48,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.569).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In moderately to severely active UC patients with PR3-ANCA+, RTX showed better effectiveness than infliximab (IFX), with a similar safety profile.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2025.1621795","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:27:10Z","timestamp":1761283630000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rituximab in PR3-ANCA positive patients with moderately to severely active ulcerative colitis: a multicenter real-world pilot study"],"prefix":"10.3389","volume":"16","author":[{"given":"Qi","family":"Yu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiyu","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yidong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaopeng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyu","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiamin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junrong","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liangru","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1186\/s12876-021-01903-5","article-title":"Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitis","volume":"21","author":"Aoyama","year":"2021","journal-title":"BMC Gastroenterol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e150999","DOI":"10.1172\/jci.insight.150999","article-title":"Circulating autoreactive proteinase 3+ B cells and tolerance checkpoints in ANCA-associated vasculitis","volume":"6","author":"Berti","year":"2021","journal-title":"JCI Insight"},{"key":"B3","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1053\/j.gastro.2011.11.009","article-title":"Rituximab in active ulcerative colitis","volume":"142","author":"Calder\u00f3n-G\u00f3mez","year":"2012","journal-title":"Gastroenterology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1016\/j.cgh.2023.08.021","article-title":"Comparative effectiveness of upadacitinib vs ustekinumab for ulcerative colitis: a multicenter retrospective cohort study","volume":"22","author":"Dalal","year":"2024","journal-title":"Clin. 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