#3-92E. Predicting Rituximab-Induced Acute Thrombocytopenia in AAV (Rheumatology, 2026)

How do you mitigate the risk of severe acute thrombocytopenia when initiating rituximab for ANCA-associated vasculitis? This study, utilizing data from the nationwide J-CANVAS registry, evaluated 175 Japanese patients with AAV to investigate rituximab-induced acute thrombocytopenia (RIAT). Researchers found that RIAT is a frequent complication, occurring in 35.4% of cases within 28 days of induction therapy. The most crucial clinical takeaway is the identification of diabetes mellitus and cardiac disease as potent predictors of RIAT, leading to the development of a highly discriminative predictive model with a C-statistic of 0.817. However, when critically appraising this study, physicians must consider its limited generalizability, as the cohort consisted exclusively of Japanese patients predominantly diagnosed with microscopic polyangiitis, and post-RTX platelet count timing was not predefined. Despite these limitations, this study is highly relevant for daily clinical practice. It provides a practical, individualized risk assessment tool that enables rheumatologists to stratify patients prior to initiating rituximab, thereby optimizing treatment strategies and proactively managing potential bleeding complications.

Citation: Akao S, Asashima H, et al. Diabetes mellitus and cardiac disease as key predictors of rituximab-induced acute thrombocytopenia in ANCA-associated vasculitis. Rheumatology. 65(1), 1-8, 2026. DOI: 10.1093/rheumatology/keaf529

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