The study focuses on two rare forms of blood vessel inflammation, granulomatosis with polyangiitis and microscopic polyangiitis. These conditions cause the immune system to attack small blood vessels, leading to problems in the lungs, kidneys and other organs. A specific blood test looks for ANCA, which are antibodies that often rise before the disease becomes active again. The medication being tested is rituximab, given through an IV, and the comparison drug is an oral steroid called prednisone, which helps lower inflammation.
The purpose of the study is to determine whether giving rituximab early when ANCA reappears can keep patients in remission better than simply checking the blood test and symptoms every three months. Participants who have already completed an 18‑month course of rituximab and are in complete remission will be randomly assigned to either receive a pre‑emptive rituximab infusion at the first sign of ANCA returning or continue with regular monitoring and standard steroid treatment.
During the two‑year follow‑up, participants will attend clinic visits roughly every three months for blood work, symptom checks and, if assigned, an IV infusion of rituximab. The main outcome measured is the time without a disease flare, using the BVAS score, where a score of zero means no disease activity. Additional observations will include the number of relapses, side effects, total steroid dose taken, and overall quality of life.
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