Comparative efficacy and safety of rituximab, mycophenolate, and cyclophosphamide in active antineutrophil cytoplasmic antibody-associated vasculitis: A Bayesian network meta-analysis of randomized controlled trials

Objective: The aim of the present study was to compare the effectiveness and safety of rituximab, mycophenolate mofetil (MMF), and cyclophosphamide (CYC) for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Materials and methods: We conducted a Bayesian network meta-analysis to incorporate direct and indirect data from six randomized controlled trials (comprising 541 patients) that investigated the effectiveness and safety of rituximab, MMF, and CYC for the treatment of patients with AAV and met the inclusion criteria. Results: Rituximab and MMF demonstrated a trend toward a higher response rate than CYC, (OR 1.41, 95% credible interval (CrI) 0.84 - 2.40) and (OR 1.20, % CrI 0.73 - 1.93), respectively. The surface under the cumulative ranking curve (SUCRA) revealed that rituximab has the highest probability of being a better remission-induction therapy (SUCRA = 0.797), followed by MMF and CYC (-SUCRA = 0.537 and 0.166, respectively). However, CYC displayed a propensity for a lower relapse than rituximab and MMF (OR 0.81, 95% CrI 0.42 - 1.50; OR 0.72, % CrI 0.39 - 1.27), further confirmed by -SUCRA rankings. Rating likelihood based on -SUCRA revealed that rituximab was more likely to be the safest medication since it displayed a lower incidence of serious adverse effects (SAEs), followed by CYC and MMF. Conclusion: Rituximab may serve as an effective remission-induction therapy for patients with AAV and decrease the incidence of SAEs. Although rituximab showed a high relapse rate, the accompanying desirable safety profile indicates that it is the first therapeutic choice for patients with AAV.