Hypogammaglobulinemia and severe infections in Multiple Sclerosis patients on anti-CD20 agents: A multicentre study

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-11-24 DOI:10.1016/j.msard.2024.106191

K. Smolik , F. Camilli , I. Panzera , A. Fiore , A. Franceschini , M. Foschi , A. Surcinelli , I. Pesci , C. Ferri , V. Bazzurri , L. Mancinelli , C. Zini , A.M. Simone , A. Lugaresi , F. Falzone , F. Granella , M.G. Piscaglia , A. Guareschi , E. Baldi , P. Immovilli , D. Ferraro

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引用次数: 0

Abstract

Background

Hypogammaglobulinemia (HG) is a known side effect of treatment with anti-CD20 monoclonal antibodies, and it is associated with the risk of infections.

Objectives

Aim of this retrospective multicentre study was to assess the frequency of HG in Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorder patients treated with Ocrelizumab or Rituximab and its association with the occurrence of severe infections (SI). Furthermore, predictors of HG and SI were sought.

Methods

We included 556 patients (190M, 366F, mean age: 47 years) with a mean follow-up of 28 months (range 12-90 months).

Results

IgG HG occurred in 20% and IgM HG in 34% of patients. At multivariable analysis, the risk of IgG HG was influenced by an older age (≥50 years) (OR 1.64, 95%CI: 1.06-2.54, p=0.027), and by the number of treatment cycles (OR: 1.20, 95%CI: 1.09-1.33, p<0.001).

A total of 25 SI occurred (100 person-years rate: 1.8), with a disease phenotype other than relapsing-remitting (OR 1.50, 95%CI: 1.02-2.20; p=0.039) and IgG HG (OR 2.65, 95%CI: 1.15-6.12; p=0.022) increasing its risk.

Conclusions

IgG and IgM HG occurred in a considerable proportion of patients. IgG HG increased the risk of SI, which were, nevertheless, relatively infrequent. Our results highlight the importance of monitoring immunoglobulin levels during treatment with anti-CD20 agents, to personalize treatment strategies.

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抗cd20药物治疗多发性硬化症患者的低γ -球蛋白血症和严重感染：一项多中心研究

背景：低γ球蛋白血症（HG）是抗cd20单克隆抗体治疗的一种已知副作用，它与感染风险相关。目的：本回顾性多中心研究的目的是评估接受Ocrelizumab或Rituximab治疗的多发性硬化症（MS）和视谱神经脊髓炎患者中HG的发生频率及其与严重感染（SI）发生的关系。此外，还寻找了HG和SI的预测因子。方法纳入556例患者（190M, 366F，平均年龄47岁），平均随访28个月（12-90个月）。结果igg HG发生率为20%，IgM HG发生率为34%。在多变量分析中，IgG HG的风险受年龄较大（≥50岁）（OR: 1.64, 95%CI: 1.06-2.54, p=0.027）和治疗周期数（OR: 1.20, 95%CI: 1.09-1.33, p<0.001）的影响。共发生25例SI(100人年发生率：1.8)，疾病表型非复发缓解(OR 1.50, 95%CI: 1.02-2.20；p=0.039)和IgG HG (OR 2.65, 95%CI: 1.15 ~ 6.12；P =0.022)增加其风险。结论sigg和IgM型HG在相当比例的患者中存在。IgG HG增加了SI的风险，尽管这种情况相对少见。我们的研究结果强调了在使用抗cd20药物治疗期间监测免疫球蛋白水平的重要性，以个性化治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.