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Predicting severe infection and effects of hypogammaglobulinaemia during therapy with rituximab in rheumatic and musculoskeletal diseases

Arthritis & Rheumatology Jun 01, 2019

Yusof MYM, et al. - Researchers conducted a retrospective longitudinal study in 700 rituximab (RTX)-treated rheumatic and musculoskeletal diseases (RMDs) patients evaluating predictors of serious infections events (SIEs) during RTX therapy. In addition, they investigated how hypogammaglobulinaemia influence SIE rates, humoral response and its persistence post-RTX discontinuation in the treatment of RMDs. Rheumatoid arthritis was reported in 507(72%), systemic lupus erythematosus in 94(13%), ANCA-associated vasculitis in 49(7%) and other RMDs in 50(8%). There were 176 patients who experienced 281 SIEs (9.8/100 PY). SIEs were noted in correlation to non-RTX-specific comorbidities (previous history of SIE, cancer, chronic lung disease, diabetes, heart failure), higher corticosteroid dose and RTX-specific factors; low IgG(<6g/L) both at baseline and subsequently, RTX-associated neutropaenia, higher IgM and longer time-to-RTX retreatment, but not B-cell numbers or depletion status. They recommend identifying patients at risk of SIEs via monitoring immunoglobulin at baseline and before each RTX cycle. Those with lower IgG should be managed via individualized benefit-risk assessment as lower IgG is a consistent SIE predictor and may enhance infection profiles when RTX is switched to different therapies.
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