Which option is commonly considered a second-line option after glucocorticoids for warm AIHA?

Which option is commonly considered a second-line option after glucocorticoids for warm AIHA?

• A. Prednisone
• B. Splenectomy
• C. IVIG
• D. Rituximab

Answer: (D)

Warm AIHA is driven by autoantibodies that tag red cells for destruction; glucocorticoids curb antibody production and phagocytosis, making them the first-line treatment. When patients relapse or fail to maintain response, second-line options aim to reduce autoantibody production or remove the primary site of destruction. Rituximab, an anti-CD20 monoclonal antibody, targets B cells and thus lowers autoantibody synthesis. This mechanism often translates into meaningful, durable remissions and is less invasive than surgical approaches. For many patients, rituximab is the favored second-line option after steroids. Splenectomy can be effective by removing the major site of red cell destruction, but it’s an invasive procedure with surgical risks and longer-term considerations, so it’s used less routinely as a first-choice second-line. IVIG provides only temporary, non-specific benefit in warm AIHA and is not a standard second-line therapy. Prednisone is the initial therapy, not the second-line choice.

Warm AIHA is driven by autoantibodies that tag red cells for destruction; glucocorticoids curb antibody production and phagocytosis, making them the first-line treatment. When patients relapse or fail to maintain response, second-line options aim to reduce autoantibody production or remove the primary site of destruction. Rituximab, an anti-CD20 monoclonal antibody, targets B cells and thus lowers autoantibody synthesis. This mechanism often translates into meaningful, durable remissions and is less invasive than surgical approaches. For many patients, rituximab is the favored second-line option after steroids.

Splenectomy can be effective by removing the major site of red cell destruction, but it’s an invasive procedure with surgical risks and longer-term considerations, so it’s used less routinely as a first-choice second-line. IVIG provides only temporary, non-specific benefit in warm AIHA and is not a standard second-line therapy. Prednisone is the initial therapy, not the second-line choice.