Induction therapy with cyclophosphamide and glucocorticoids results in remission in most patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis; however, many patients relapse on maintenance therapy with azathioprine or methotrexate. A study has now compared relapse rates in patients with vasculitis in complete remission (n = 115; 87 with granulomatosis with polyangiitis, 23 with microscopic polyangiitis and 5 with renal-limited ANCA-associated vasculitis) receiving 500 mg rituximab on days 0 and 14, and at months 6, 12 and 18 (n = 57), or azathioprine daily until month 22 (n = 58). At month 28, 17 patients receiving azathioprine (29%) and 3 patients receiving rituximab (5%; HR for relapse 6.61, 95% CI 1.56–27.96, P = 0.002) had undergone a major relapse, indicating that rituximab could be an efficacious remission maintenance therapy for ANCA-associated vasculitis. Frequencies of severe adverse events were similar in the two groups: 44 events occurred in the azathioprine group and 45 in the rituximab group.