en Reumatology Reumatology Original Article Original Article <span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:14pt"><b><i><span style="color:blue">Background</span></i></b><i><span style="color:blue">:</span></i> Granulomatosis with polyangiitis (GPA) is a rare disease affecting medium-small vessels, causing granuloma formation and inflammation. This study aimed to assess the efficacy and safety of RTX versus Azathioprine (AZA) for maintenance treatment in GPA patients. </span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Methods:</span></i></b> This retrospective cohort study involved a review of medical records of recently diagnosed GPA patients undergoing maintenance treatment with RTX or AZA. The main variable was the frequency of relapses within an 18-month follow-up period. Additionally, the study compared changes in BVAS.WG score (The Birmingham Vasculitis Activity Score-Wegner specific) and Damage (vasculitis damage index (VDI)), mortality, and treatment complications between the two groups.</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Results:</span></i></b> Among the 43 patients receiving RTX maintenance treatment, 8 (18.6%) experienced relapses during 24 months follow-up, while 14 (66.6%) out of the 21 patients receiving AZA relapsed (Hazard Ratio = 6.9 and 95% confidence interval = 1.95-19.3, p <001). Notably, the increase in the BVAS-WG score was significantly lower in the RTX group compared to the AZA group (p <001). The cumulative steroid dose was 143<span dir="RTL" lang="FA">&plusmn;</span>21 mg in the RTX group and 125&plusmn;25 mg in the AZA group (P = 0.1). Treatment side effects were similar in both groups (p >0.05). </span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Conclusion</span></i></b><i><span style="color:blue">:</span></i> Maintenance treatment with RTX is associated with better treatment response and lower relapse rate compared to AZA. There was no difference in treatment complications between AZA or RTX in maintenance treatment. </span></span></span><br> &nbsp; Granulomatosis with polyangiitis (GPA), Rituximab, Azathioprine, Antineutrophilic Cytoplasmic Antibody (ANCA) 480 486 http://caspjim.com/browse.php?a_code=A-10-3369-1&slc_lang=en&sid=1 Samira Alesaeidi S-alesaeidi@sina.tums.ac.ir 100319475328460053306 100319475328460053306 No Department of Internal Medicine and Rheumatology, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Masoud Radnia m.radnia1317@gmail.com 100319475328460053307 0009-0009-2016-1534 No Department of Internal Medicine and Rheumatology, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Soheil Tavakolpour Soheil_tavakolpour@dfci.harvard.edu 100319475328460053308 100319475328460053308 No Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America Seyed Behnam Jazayeri Drbehnamjazayeri@gmail.com 100319475328460053309 100319475328460053309 No Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran Shima Loni drshimaloni@gmail.com 100319475328460053310 0009-0003-5747-4709 Yes Department of Internal Medicine and Rheumatology, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.