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CompletedNCT01731561MAINRITSAN 2Updated Sep 5, 2025

Comparison Study of Two Rituximab Regimens in the Remission of ANCA Associated Vasculitis

A Phase 3 interventional study of Rituximab (Arm B) and Rituximab (Arm A) in Granulomatosis With Polyangiitis, Microscopic Polyangiitis and Renal Limited Forms, sponsored by Assistance Publique - Hôpitaux de Paris. Completed at 1 site in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-09-05.

Sponsored by Assistance Publique - Hôpitaux de Paris · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
166
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The aim of this study is to assess the efficacy of a rituximab regimen based on rate of ANCA and CD19 lymphocytes for maintenance treatment in systemic ANCA-associated vasculitis: prospective, multicenter, controlled, randomized comparative study of two rituximab regimens: one based on ANCA and CD19 lymphocytes versus systematic infusions.

Read the detailed description

Randomized, controlled, national, multicenter, prospective study to compare systematic rituximab infusions (conventional therapy) to rituximab infusion based on rate of ANCA and CD19 lymphocytes in patients with systemic ANCA-associated vasculitis, in remission (achieved with an induction treatment combining corticosteroids and an immunosuppressant after the first flare of the disease (new diagnosis) or after a relapse. Patients will be stratified by first flare (66% of the patients) or relapse (33% of the patients). Patients complying with the inclusion criteria may be included when they are in remission from their vasculitis. Patients will be included at the time of remission and then randomized. They will receive maintenance treatment by 1)2 rituximab infusions mg at D1, D15 then every 6 months until month 18 (i.e. a total of 5 infusions), at the dose of 500 mg. 2) 1 rituximab infusion at the dose of 500 mg at D0 then ANCA status and CD19+ lymphocyte count will be monitored every 3 months, and patients will receive new 500 mg rituximab infusions either if CD19 are > to 0/mm3, or if ANCA are positive again or if ANCA titer significantly raises. After the 18 month length of maintenance phase, i.e. after stopping immunosuppressive maintenance therapy, patients will be followed for an additional 10 month period. Patients with granulomatosis with polyangiitis will be prescribed cotrimoxazole 160/800 tid (for 2 additional years).

02

Conditions studied

  • Granulomatosis With Polyangiitis
  • Microscopic Polyangiitis
  • Renal Limited Forms

Keywords

  • Granulomatosis with Polyangiitis
  • Microscopic polyangiitis
  • Renal limited forms
  • ANCA-associated vasculitis
  • Rituximab
03

In context

Granulomatosis with Polyangiitis

104 studies on the registry are indexed under Granulomatosis with Polyangiitis; 16 are open to participants now.

This study's enrollment of 166 is above the median of 70 across 69 interventional studies indexed under Granulomatosis with Polyangiitis.

Browse Granulomatosis with Polyangiitis studies →

Lead sponsor

Assistance Publique - Hôpitaux de Paris is the lead sponsor of 3,592 studies on the registry; 1,033 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Granulomatosis with Polyangiitis Or microscopic polyangiitis complying Or kidney-limited disease With or without detectable ANCA (anti-neutrophil cytoplasmic antibodies) at the time of diagnosis or relapse, and at remission.
  • Who have achieved remission using a treatment combining and an agent, including corticosteroids, cyclophosphamide IV or oral (the use of another immunosuppressant is allowed, according to the current French guidelines, as well as plasma exchanges and/or IV immunoglobulins, or rituximab).
  • Interval of 1 month between the end of the immunosuppressant treatment and the randomization time if cyclophosphamide or methotrexate were used, interval between 4 and 6 months if rituximab was used
  • Age > 18 years without age limit higher when the diagnosis is confirmed.
  • Informed and having signed the consent form to take part in the study.

Exclusion criteria

Exclusion Criteria:

  • Other systemic vasculitis
  • Secondary vasculitis (following neoplastic disease or an infection in particular)
  • Induction treatment with a regimen not corresponding to that recommended in France.
  • Patient who has not achieved remission.
  • Incapacity or refusal to understand or sign the form.
  • Incapacity or refusal to adhere to treatment or perform the follow-up examinations required by the study. Non-compliance
  • Allergy, documented or to the study medication (cyclophosphamide, , azathioprine, rituximab)
  • History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies.
  • Pregnancy, breastfeeding. Women of childbearing age must use a reliable method of throughout the duration of treatment up to 1 year after the last infusion of rituximab
  • Infection by , or
  • Progressive, uncontrolled infection requiring a prolonged treatment (tuberculosis, HIV infection, etc.).
  • Severe infection declared during the 3 months before randomization (CMV, HBV, HHV8, HCV, HIV, tuberculosis).
  • Progressive cancer or malignant blood disease diagnosed during the 5 years before the diagnosis of vasculitis. Patients suffering from non- prostate cancer or those cured of a cancer or a malignant blood disorder for more than 5 years and not taking any antineoplastic agents for more than 5 years may be included.
  • Participation in another clinical research protocol during the 4 weeks before inclusion.
  • Any medical or psychiatric disorder which, in the investigator's opinion, may prevent the administration of treatment and patient follow-up according to the protocol, and/or which may expose the patient to a too greater risk of an adverse effect.
  • No social security
  • Churg and Strauss syndrome
  • Viral, bacterial or fungic or mycobacterial infection uncontrolled in the 4 weeks before the inclusion
  • History of deep tissue infection (fasciitis, osteomyelitis, septic arthritis)in the first year before the inclusion
  • History of chronic and severe or recurrent infection or history of preexisting disease predisposing to severe infection
  • Severe immunodepression
  • Administration of in the four weeks before inclusion
  • Severe chronic obstructive pulmonary diseases (VEMS \< 50 % or dyspnea grade III)
  • Chronic heart failure stade III and IV ()
  • History of recent acute coronary syndrome, unrelated to vasculitis
Terms in these criteria, in plain language(12)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Live vaccines

Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
166 participants (actual)

Study arms

  • Experimental
    Rituximab infusion according biological parameters

    Rituximab infusion based on ANCA and CD19 lymphocytes

    Drug: Rituximab (Arm B)

  • Active comparator
    Systematic rituximab infusion

    Semestrial rituximab infusion until 18 months

    Drug: Rituximab (Arm A)

Interventions

  • Rituximab infusion will be performed at D1 then ANCA status and CD19+ lymphocyte count will be monitored every 3 months, and patients will receive new 500 mg rituximab infusions either if CD19 are \> to 0/mm3, or if ANCA are positive again or if ANCA titer significantly raises. All patients received corticosteroids, starting from induction with prednisone (or equivalent) at a dose of 1 mg/kg/day with gradual tapering according to a regimen adjusted to body weight over a mean of 18 months since diagnosis.

  • Rituximab infusion will be performed at D1, D15, M6, M12 and M18(i.e. a total of 5 infusions), at the dose of 500 mg at a fixed dosage.All patients received corticosteroids, starting from induction with prednisone (or equivalent) at a dose of 1 mg/kg/day with gradual tapering according to a regimen adjusted to body weight over a mean of 18 months since diagnosis.

06

What researchers measure

Primary outcomes

  1. Number of relapses

    Number of relapses (BVAS\>0) majors and minors in each group at the end of the maintenance treatment (18 months treatment + 10 months follow-up)

    Time frame: at 28 months

Secondary outcomes

  1. Number of patients with ANCA (Anti-Neutrophil Cytoplasmatic Antibodies)

    Number of patients with ANCA in each group

    Time frame: at 28 months

  2. Number of adverse events

    To assess the number of adverse events and their severity in each group

    Time frame: at 28 months

  3. Mortality rate

    To assess mortality rate in each group

    Time frame: at 28 months

  4. Number of minor relapse

    number of minor relapse in each group

    Time frame: at 28 months

  5. Cumulated dose of corticosteroid treatment

    Cumulated dose of corticosteroid treatment in each group at 28 months

    Time frame: at 28 months

  6. Number and severity of damages

    Number and severity of damages in each group

    Time frame: at 28 months

  7. Evolution of ANCA and the link of the clinical events

    Evolution of ANCA in each group and the link of the clinical events

    Time frame: at 28 months

  8. Distribution of events by severity

    Distribution of events by severity and it will be assigned to the drug and its mode of administration and/or the severity of the disease (in each group).

    Time frame: at 28 months

  9. Length of corticosteroid treatment

    The length of corticosteroid treatment in each group at 28 months

    Time frame: at 28 months

  10. Rate of B-Lymphocytes CD-19 and the link of the clinical events

    The rate of B-Lymphocytes CD-19 and the link of the clinical events

    Time frame: at 28 months

  11. Evolution of gammaglobulins

    Time frame: at 28 months

  12. Quality of life : SF36 (The Short Form (36) Health Survey)

    Time frame: at 28 months

  13. Functional capacities : HAQ (Health Assessment Questionnaire)

    Time frame: at 28 months

07

Study locations

1 site
  • Cochin Hospital
    Paris, 75014, France
08

References and documents

Publications

  • Charles P, Terrier B, Perrodeau E, Cohen P, Faguer S, Huart A, Hamidou M, Agard C, Bonnotte B, Samson M, Karras A, Jourde-Chiche N, Lifermann F, Gobert P, Hanrotel-Saliou C, Godmer P, Martin-Silva N, Pugnet G, Matignon M, Aumaitre O, Viallard JF, Maurier F, Meaux-Ruault N, Riviere S, Sibilia J, Puechal X, Ravaud P, Mouthon L, Guillevin L; French Vasculitis Study Group. Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2). Ann Rheum Dis. 2018 Aug;77(8):1143-1149. doi: 10.1136/annrheumdis-2017-212878. Epub 2018 Apr 25. PubMed 29695500 ↗
  • Khoudour N, Delestre F, Jabot-Hanin F, Jouinot A, Nectoux J, Letouneur F, Izac B, Vidal M, Guillevin L, Puechal X, Charles P, Terrier B, Blanchet B. Association Between Plasma Rituximab Concentration and the Risk of Major Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitides During Rituximab Maintenance Therapy. Arthritis Rheumatol. 2023 Nov;75(11):2003-2013. doi: 10.1002/art.42556. Epub 2023 Aug 13. PubMed 37134130 ↗
09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Nov 2012 to primary completion in Apr 2016, 40 months.

How these figures are worked out, and which studies are left out of them.

Registered
Oct 12, 2012
First posted
Nov 22, 2012
StartActual
Nov 16, 2012
Primary completionActual
Apr 5, 2016
CompletionActual
Apr 5, 2016
Last update
Sep 5, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 5, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT01731561
Collaborators
URC-CIC Paris Descartes Necker Cochin
Responsible party
Sponsor
First posted
Nov 22, 2012
Start date
Nov 16, 2012
Primary completion
Apr 5, 2016
Completion
Apr 5, 2016
Last update
Sep 5, 2025

Study contacts

Loic Guillevin, MD, PhD
study chair · Cochin Hospital, Paris, France
Pierre Charles, MD
study chair · Institut mutualiste, Paris, France

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Rituximab

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