Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease
ObjectiveTo evaluate the characteristics of patients with autoimmune disease with hypogammaglobulinemia following rituximab (RTX) and describe their long-term outcomes, including those who commenced immunoglobulin replacement therapy.MethodsPatients received RTX for autoimmune disease between 2003 a...
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| Format: | Article |
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Frontiers Media S.A.
2021-05-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2021.671503/full |
| _version_ | 1818640677853986816 |
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| author | Joanna Tieu Joanna Tieu Joanna Tieu Rona M. Smith Rona M. Smith Seerapani Gopaluni Seerapani Gopaluni Dinakantha S. Kumararatne Mark McClure Mark McClure Ania Manson Sally Houghton David R. W. Jayne David R. W. Jayne |
| author_facet | Joanna Tieu Joanna Tieu Joanna Tieu Rona M. Smith Rona M. Smith Seerapani Gopaluni Seerapani Gopaluni Dinakantha S. Kumararatne Mark McClure Mark McClure Ania Manson Sally Houghton David R. W. Jayne David R. W. Jayne |
| author_sort | Joanna Tieu |
| collection | DOAJ |
| description | ObjectiveTo evaluate the characteristics of patients with autoimmune disease with hypogammaglobulinemia following rituximab (RTX) and describe their long-term outcomes, including those who commenced immunoglobulin replacement therapy.MethodsPatients received RTX for autoimmune disease between 2003 and 2012 with immunoglobulin G (IgG) <7g/L were included in this retrospective series. Hypogammaglobulinemia was classified by nadir IgG subgroups of 5 to <7g/L (mild), 3 to <5g/L (moderate) and <3g/L (severe). Characteristics of patients were compared across subgroups and examined for factors associated with greater likelihood of long term hypogammaglobulinemia or immunoglobulin replacement.Results142 patients were included; 101 (71%) had anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV), 18 (13%) systemic lupus erythematosus (SLE) and 23 (16%) other conditions. Mean follow-up was 97.2 months from first RTX. Hypogammaglobulinemia continued to be identified during long-term follow-up. Median time to IgG <5g/L was 22.5 months. Greater likelihood of moderate hypogammaglobulinemia (IgG <5g/L) and/or use of immunoglobulin replacement therapy at 60 months was observed in patients with prior cyclophosphamide exposure (odds ratio (OR) 3.60 [95% confidence interval (CI) 1.03 – 12.53], glucocorticoid use at 12 months [OR 7.48 (95% CI 1.28 – 43.55], lower nadir IgG within 12 months of RTX commencement [OR 0.68 (95% CI 0.51 – 0.90)] and female sex [OR 8.57 (95% CI 2.07 – 35.43)]. Immunoglobulin replacement was commenced in 29/142 (20%) and associated with reduction in infection rates, but not severe infection rates.ConclusionHypogammaglobulinemia continues to occur in long-term follow-up post-RTX. In patients with recurrent infections, immunoglobulin replacement reduced rates of non-severe infections. |
| first_indexed | 2024-12-16T23:15:05Z |
| format | Article |
| id | doaj.art-bd3ce9c9a88440ebad989131ab748a89 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-16T23:15:05Z |
| publishDate | 2021-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-bd3ce9c9a88440ebad989131ab748a892022-12-21T22:12:20ZengFrontiers Media S.A.Frontiers in Immunology1664-32242021-05-011210.3389/fimmu.2021.671503671503Rituximab Associated Hypogammaglobulinemia in Autoimmune DiseaseJoanna Tieu0Joanna Tieu1Joanna Tieu2Rona M. Smith3Rona M. Smith4Seerapani Gopaluni5Seerapani Gopaluni6Dinakantha S. Kumararatne7Mark McClure8Mark McClure9Ania Manson10Sally Houghton11David R. W. Jayne12David R. W. Jayne13Department of Medicine, University of Cambridge, Cambridge, United KingdomVasculitis and Lupus Clinic, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United KingdomAdelaide Medical School, University of Adelaide, Adelaide, SA, AustraliaDepartment of Medicine, University of Cambridge, Cambridge, United KingdomVasculitis and Lupus Clinic, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United KingdomDepartment of Medicine, University of Cambridge, Cambridge, United KingdomVasculitis and Lupus Clinic, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United KingdomClinical Immunology Unit, Cambridge University Hospitals NHS Trust, Cambridge, United KingdomDepartment of Medicine, University of Cambridge, Cambridge, United KingdomVasculitis and Lupus Clinic, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United KingdomClinical Immunology Unit, Cambridge University Hospitals NHS Trust, Cambridge, United KingdomClinical Immunology Unit, Cambridge University Hospitals NHS Trust, Cambridge, United KingdomDepartment of Medicine, University of Cambridge, Cambridge, United KingdomVasculitis and Lupus Clinic, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United KingdomObjectiveTo evaluate the characteristics of patients with autoimmune disease with hypogammaglobulinemia following rituximab (RTX) and describe their long-term outcomes, including those who commenced immunoglobulin replacement therapy.MethodsPatients received RTX for autoimmune disease between 2003 and 2012 with immunoglobulin G (IgG) <7g/L were included in this retrospective series. Hypogammaglobulinemia was classified by nadir IgG subgroups of 5 to <7g/L (mild), 3 to <5g/L (moderate) and <3g/L (severe). Characteristics of patients were compared across subgroups and examined for factors associated with greater likelihood of long term hypogammaglobulinemia or immunoglobulin replacement.Results142 patients were included; 101 (71%) had anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV), 18 (13%) systemic lupus erythematosus (SLE) and 23 (16%) other conditions. Mean follow-up was 97.2 months from first RTX. Hypogammaglobulinemia continued to be identified during long-term follow-up. Median time to IgG <5g/L was 22.5 months. Greater likelihood of moderate hypogammaglobulinemia (IgG <5g/L) and/or use of immunoglobulin replacement therapy at 60 months was observed in patients with prior cyclophosphamide exposure (odds ratio (OR) 3.60 [95% confidence interval (CI) 1.03 – 12.53], glucocorticoid use at 12 months [OR 7.48 (95% CI 1.28 – 43.55], lower nadir IgG within 12 months of RTX commencement [OR 0.68 (95% CI 0.51 – 0.90)] and female sex [OR 8.57 (95% CI 2.07 – 35.43)]. Immunoglobulin replacement was commenced in 29/142 (20%) and associated with reduction in infection rates, but not severe infection rates.ConclusionHypogammaglobulinemia continues to occur in long-term follow-up post-RTX. In patients with recurrent infections, immunoglobulin replacement reduced rates of non-severe infections.https://www.frontiersin.org/articles/10.3389/fimmu.2021.671503/fullrituximabhypogammaglobulinemiaautoimmune diseaseimmunoglobulin replacement therapyB-cell |
| spellingShingle | Joanna Tieu Joanna Tieu Joanna Tieu Rona M. Smith Rona M. Smith Seerapani Gopaluni Seerapani Gopaluni Dinakantha S. Kumararatne Mark McClure Mark McClure Ania Manson Sally Houghton David R. W. Jayne David R. W. Jayne Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease Frontiers in Immunology rituximab hypogammaglobulinemia autoimmune disease immunoglobulin replacement therapy B-cell |
| title | Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease |
| title_full | Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease |
| title_fullStr | Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease |
| title_full_unstemmed | Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease |
| title_short | Rituximab Associated Hypogammaglobulinemia in Autoimmune Disease |
| title_sort | rituximab associated hypogammaglobulinemia in autoimmune disease |
| topic | rituximab hypogammaglobulinemia autoimmune disease immunoglobulin replacement therapy B-cell |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2021.671503/full |
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