Sorin B, Samson M, Durel CA, et al. - For patients with persistently active granulomatosis with polyangiitis (GPA) with granulomatous manifestations, rituximab and methotrexate (RTX/MTX) combination therapy could serve as an effective as well as safe treatment option when administered as salvage therapy.

• A retrospective French nationwide study including 17 patients with ANCA-associated vasculitides who were treated with RTX/MTX combination therapy for persistently active disease.

• RTX/MTX combination therapy was needed due to subglottic or bronchial stenosis in 6 patients (35%), orbital mass in 6 (35%), disabling ENT involvement in 2 (12%), and epiduritis and pachymeningitis in 1 case each (6%).

• A total of 15 patients (88%) achieved global response at 6 months [partial response in 11 (65%) and complete response in 4 (24%)], and 16 patients (94%) achieved global response at last evaluation.

• Severe adverse events (grade 3 or 4) occurred in 7 patients (41%).

• In 4 cases (24%), withdrawal of combination therapy was noted but never for safety concerns.