Efficacy and Safety of Biologics and Immunosuppressants in Maintenance Therapy for Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Network Meta-Analysis

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a potentially life-threatening systemic autoimmune disease. This study aims to compare the effectiveness and safety of biologics and immunosuppressive agents in the maintenance treatment of AAV. A comprehensive search was conducted in Medline, PubMed, Embase, and the Cochrane Library databases to identify the relevant randomised controlled trials (RCTs). Nine RCTs involving 1,157 patients were included. For primary efficacy, rituximab had a lower relapse rate than azathioprine (AZA) and mycophenolate mofetil (MMF) (odds ratio (OR): 0.47, 95% confidence interval (CI): 0.26-0.84 and OR: 0.23, 95% CI: 0.08-0.68, respectively). Based on the result of the surface under the cumulative ranking curve (SUCRA), rituximab had the highest probability of reducing relapse (SUCRA = 86.6%), followed by cyclophosphamide (CYC), belimumab + AZA, methotrexate (MTX), AZA, and MMF. Regarding major relapse, rituximab also showed the highest probability (SUCRA = 93.6%). Concerning safety, there were no significant differences in the incidence of SAEs and serious infection among the different medicines. According to the SUCRA, MMF had the lowest probability of SAEs and serious infection. In conclusion, rituximab may be a treatment method for effectively reducing relapses in AAV patients during maintenance therapy among the medicines investigated. MMF has shown the lowest incidence of SAEs and serious infection. Key Words: Immunosuppressant, Rituximab, Meta-analysis.