Rituximab-associated hypogammaglobulinemia in ANCA-associated vasculitis: Incidence and time course.

IF 1.3 Q4 RHEUMATOLOGY
Anam Tariq, Ayobami Akenroye, Antoine Azar, Philip Seo, Duvuru Geetha
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引用次数: 4

Abstract

Objective: Rituximab (RTX) is approved for remission induction and maintenance of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). Observational studies demonstrate decline in immunoglobulin (IgG) in AAV post-RTX. The time course for the onset of hypogammaglobulinemia (Hypo-IgG) post-RTX is unknown. This is a key determinant in deciding whether to continue RTX for reinduction or maintenance of remission for AAV. We evaluated the trends of Hypo-IgG among AAV patients post-RTX therapies.

Methods: An observational single-tertiary-center study of AAV patients treated with RTX for remission induction or maintenance (induction therapy, maintenance therapy, and combined induction and maintenance therapy) between 1998 and 2018. Poisson regression was used to compare the inciden- ces of Hypo-IgG: mild (450-700 mg dL-1), moderate (200-450 mg dL-1), and severe (􏰃200 mg dL-1). Ig levels were measured every 3-6 months after RTX use.

Results: Mean (SD) age at last visit was 59 (16) years, 93% were Caucasians, 64% were females, and 71 (63%) had granulomatosis with polyangiitis (GPA). Hypo-IgG occurred in 47 patients: one (2%) severe, 13 (28%) moderate, and 33 (70%) mild. Lower incidences of mild Hypo-IgG post-RTX were seen during induction compared to maintenance (IR 5.04 per 100 000 days vs 5.45 per 100 000 days, incidence rate ratio (IRR) 1.08, 95% CI 0.34, 3.19). Moderate Hypo-IgG occurred at 2.29 per 100 000 days during induc- tion and 1.82 per 100 000 days during maintenance (IRR 0.79, 95% CI 0.08, 4.84).

Conclusion: Hypo-IgG is common among AAV treated with RTX, occurring in 42% of patients in this single-center cohort. The nadir IgG levels occur during remission induction, and the IgG levels remain relatively stable or increase over time in those receiving RTX for remission maintenance.

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anca相关性血管炎的利妥昔单抗相关低丙种球蛋白血症:发病率和病程。
目的:利妥昔单抗(RTX)被批准用于抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)的缓解、诱导和维持。观察性研究表明,rtx后AAV免疫球蛋白(IgG)下降。rtx后低γ球蛋白血症(低igg)发作的时间过程尚不清楚。这是决定是否继续RTX治疗AAV再诱导或维持缓解的关键决定因素。我们评估了rtx治疗后AAV患者中低igg的趋势。方法:对1998年至2018年间接受RTX治疗的AAV患者进行观察性单三中心研究,以诱导或维持缓解(诱导治疗、维持治疗、诱导和维持联合治疗)。使用泊松回归比较低igg的发生率:轻度(450-700 mg dL-1)、中度(200-450 mg dL-1)和重度(􏰃200 mg dL-1)。RTX使用后每3-6个月测量Ig水平。结果:最后一次访问的平均(SD)年龄为59(16)岁,93%为白种人,64%为女性,71(63%)患有肉芽肿病合并多血管炎(GPA)。47例患者出现低igg: 1例(2%)重度,13例(28%)中度,33例(70%)轻度。与维持期相比,诱导期rtx后轻度低igg的发生率较低(IRR为5.04 / 10万天vs 5.45 / 10万天,发病率比(IRR) 1.08, 95% CI 0.34, 3.19)。中度低igg的发生率在诱导期间为2.29 / 10万天,在维持期间为1.82 / 10万天(IRR 0.79, 95% CI 0.08, 4.84)。结论:低igg在RTX治疗的AAV中很常见,在单中心队列中有42%的患者出现。IgG水平的最低点发生在缓解诱导期间,在接受RTX维持缓解的患者中,IgG水平保持相对稳定或随时间增加。
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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