Infectious risk when prescribing rituximab in patients with hypogammaglobulinemia acquired in the setting of autoimmune diseases
•Rituximab has been used in autoimmune diseases other than rheumatoid arthritis.•Hypogammaglobulinemia is a well-known side effect of rituximab treatment.•Hypogammaglobulinemia has been associated with an increased risk of infection.•Prescriber may decide to initiate or continue rituximab despite hy...
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| Veröffentlicht in: | International immunopharmacology 2023-07, Vol.120, p.110342-110342, Article 110342 |
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| creator | Boumaza, Xavier Lafaurie, Margaux Treiner, Emmanuel Walter, Ondine Pugnet, Gregory Martin-Blondel, Guillaume Biotti, Damien Ciron, Jonathan Constantin, Arnaud Tauber, Marie Puisset, Florent Moulis, Guillaume Alric, Laurent Renaudineau, Yves Chauveau, Dominique Sailler, Laurent |
| description | •Rituximab has been used in autoimmune diseases other than rheumatoid arthritis.•Hypogammaglobulinemia is a well-known side effect of rituximab treatment.•Hypogammaglobulinemia has been associated with an increased risk of infection.•Prescriber may decide to initiate or continue rituximab despite hypogammaglobulinemia.•There are few data depicting infectious risk after acquired hypogammaglobulinemia.
We conducted a single-centre retrospective cohort study in a French University Hospital between 2010 and 2018 to describe the risk of severe infectious event (SIE) within 2 years after the date of first rituximab infusion (T0) prescribed after the evidence of acquired hypogammaglobulinemia (gamma globulins [GG] ≤ 6 g/L) in the setting of autoimmune diseases (AID) other than rheumatoid arthritis. SIE occurred in 26 out of 121 included patients. Two years cumulative incidence rates were 12.7 % (95 % CI 5.1–23.9) in the multiple sclerosis/neuromyelitis optica spectrum disorder group (n = 48), 27.6 % (95 % CI 15.7–40.9) in the ANCA-associated vasculitis group (n = 48) and 30.6 % (95 % CI 13.1–50.3) in the ‘other AID’ group (n = 25). Median GG level at T0 was 5.3 g/l (IQR 4.1–5.6) in the 'SIE' group and 5.6 g/l (IQR 4.7–5.8) in the 'no SIE' group (p = 0.04).
In regression analysis, risk of SIE increased with Charlson comorbidity index ≥ 3 (OR 2.77; 95 % CI 1.01–7.57), lung disease (OR 3.20; 95 % CI 1.27–7.99), GG |
| doi_str_mv | 10.1016/j.intimp.2023.110342 |
| format | Article |
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We conducted a single-centre retrospective cohort study in a French University Hospital between 2010 and 2018 to describe the risk of severe infectious event (SIE) within 2 years after the date of first rituximab infusion (T0) prescribed after the evidence of acquired hypogammaglobulinemia (gamma globulins [GG] ≤ 6 g/L) in the setting of autoimmune diseases (AID) other than rheumatoid arthritis. SIE occurred in 26 out of 121 included patients. Two years cumulative incidence rates were 12.7 % (95 % CI 5.1–23.9) in the multiple sclerosis/neuromyelitis optica spectrum disorder group (n = 48), 27.6 % (95 % CI 15.7–40.9) in the ANCA-associated vasculitis group (n = 48) and 30.6 % (95 % CI 13.1–50.3) in the ‘other AID’ group (n = 25). Median GG level at T0 was 5.3 g/l (IQR 4.1–5.6) in the 'SIE' group and 5.6 g/l (IQR 4.7–5.8) in the 'no SIE' group (p = 0.04).
In regression analysis, risk of SIE increased with Charlson comorbidity index ≥ 3 (OR 2.77; 95 % CI 1.01–7.57), lung disease (OR 3.20; 95 % CI 1.27–7.99), GG < 4 g/L (OR 3.39; 95 % CI 1.02–11.19), concomitant corticosteroid therapy (OR 4.13; 95 % CI 1.63–10.44), previous cyclophosphamide exposure (OR 2.69; 95 % CI 1.10–6.61), a lymphocyte count < 1000 cells/µL (OR 2.86; 95 % CI 1.12–7.21) and absence of pneumococcal vaccination (OR 3.50; 95 % CI 1.41–8.70).
These results may help to inform clinical decision when considering a treatment by rituximab in immunosuppressed AID patients with hypogammaglobulinemia.</description><identifier>ISSN: 1567-5769</identifier><identifier>EISSN: 1878-1705</identifier><identifier>DOI: 10.1016/j.intimp.2023.110342</identifier><identifier>PMID: 37276827</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Agammaglobulinemia - chemically induced ; Agammaglobulinemia - drug therapy ; Agammaglobulinemia - epidemiology ; Arthritis, Rheumatoid - drug therapy ; Autoimmune Diseases - chemically induced ; Autoimmune Diseases - drug therapy ; Humans ; Hypogammaglobulinemia ; Infections - chemically induced ; Infectious risk ; Life Sciences ; Retrospective Studies ; Rituximab ; Rituximab - adverse effects</subject><ispartof>International immunopharmacology, 2023-07, Vol.120, p.110342-110342, Article 110342</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-ee472bb18ac0b397c673dc21a75c8b530ae78651149b13fd33451e00981f00153</citedby><cites>FETCH-LOGICAL-c442t-ee472bb18ac0b397c673dc21a75c8b530ae78651149b13fd33451e00981f00153</cites><orcidid>0000-0003-0569-629X ; 0000-0002-3386-6308 ; 0000-0001-6249-4534 ; 0000-0001-7618-3585 ; 0000-0002-8363-7028</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.intimp.2023.110342$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37276827$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04179905$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Boumaza, Xavier</creatorcontrib><creatorcontrib>Lafaurie, Margaux</creatorcontrib><creatorcontrib>Treiner, Emmanuel</creatorcontrib><creatorcontrib>Walter, Ondine</creatorcontrib><creatorcontrib>Pugnet, Gregory</creatorcontrib><creatorcontrib>Martin-Blondel, Guillaume</creatorcontrib><creatorcontrib>Biotti, Damien</creatorcontrib><creatorcontrib>Ciron, Jonathan</creatorcontrib><creatorcontrib>Constantin, Arnaud</creatorcontrib><creatorcontrib>Tauber, Marie</creatorcontrib><creatorcontrib>Puisset, Florent</creatorcontrib><creatorcontrib>Moulis, Guillaume</creatorcontrib><creatorcontrib>Alric, Laurent</creatorcontrib><creatorcontrib>Renaudineau, Yves</creatorcontrib><creatorcontrib>Chauveau, Dominique</creatorcontrib><creatorcontrib>Sailler, Laurent</creatorcontrib><title>Infectious risk when prescribing rituximab in patients with hypogammaglobulinemia acquired in the setting of autoimmune diseases</title><title>International immunopharmacology</title><addtitle>Int Immunopharmacol</addtitle><description>•Rituximab has been used in autoimmune diseases other than rheumatoid arthritis.•Hypogammaglobulinemia is a well-known side effect of rituximab treatment.•Hypogammaglobulinemia has been associated with an increased risk of infection.•Prescriber may decide to initiate or continue rituximab despite hypogammaglobulinemia.•There are few data depicting infectious risk after acquired hypogammaglobulinemia.
We conducted a single-centre retrospective cohort study in a French University Hospital between 2010 and 2018 to describe the risk of severe infectious event (SIE) within 2 years after the date of first rituximab infusion (T0) prescribed after the evidence of acquired hypogammaglobulinemia (gamma globulins [GG] ≤ 6 g/L) in the setting of autoimmune diseases (AID) other than rheumatoid arthritis. SIE occurred in 26 out of 121 included patients. Two years cumulative incidence rates were 12.7 % (95 % CI 5.1–23.9) in the multiple sclerosis/neuromyelitis optica spectrum disorder group (n = 48), 27.6 % (95 % CI 15.7–40.9) in the ANCA-associated vasculitis group (n = 48) and 30.6 % (95 % CI 13.1–50.3) in the ‘other AID’ group (n = 25). Median GG level at T0 was 5.3 g/l (IQR 4.1–5.6) in the 'SIE' group and 5.6 g/l (IQR 4.7–5.8) in the 'no SIE' group (p = 0.04).
In regression analysis, risk of SIE increased with Charlson comorbidity index ≥ 3 (OR 2.77; 95 % CI 1.01–7.57), lung disease (OR 3.20; 95 % CI 1.27–7.99), GG < 4 g/L (OR 3.39; 95 % CI 1.02–11.19), concomitant corticosteroid therapy (OR 4.13; 95 % CI 1.63–10.44), previous cyclophosphamide exposure (OR 2.69; 95 % CI 1.10–6.61), a lymphocyte count < 1000 cells/µL (OR 2.86; 95 % CI 1.12–7.21) and absence of pneumococcal vaccination (OR 3.50; 95 % CI 1.41–8.70).
These results may help to inform clinical decision when considering a treatment by rituximab in immunosuppressed AID patients with hypogammaglobulinemia.</description><subject>Agammaglobulinemia - chemically induced</subject><subject>Agammaglobulinemia - drug therapy</subject><subject>Agammaglobulinemia - epidemiology</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Autoimmune Diseases - chemically induced</subject><subject>Autoimmune Diseases - drug therapy</subject><subject>Humans</subject><subject>Hypogammaglobulinemia</subject><subject>Infections - chemically induced</subject><subject>Infectious risk</subject><subject>Life Sciences</subject><subject>Retrospective Studies</subject><subject>Rituximab</subject><subject>Rituximab - adverse effects</subject><issn>1567-5769</issn><issn>1878-1705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtv1TAQhSNERUvhHyDkJSxy60ccJxukqgJa6Ups2rVlO5ObueRV2-ljx0_HUUqXrGyd-WZGc06WfWJ0xygrL447HCMO845TLnaMUVHwN9kZq1SVM0Xl2_SXpcqlKuvT7H0IR0qTXrB32alQXJUVV2fZn5uxBRdxWgLxGH6Txw5GMnsIzqPF8ZDUuDzhYCzBVDARYYyBPGLsSPc8TwczDObQT3bpcYQBDTHufkEPzcrHDkiAGNdBU0vMEicchmUE0mAAEyB8yE5a0wf4-PKeZ3c_vt9eXef7Xz9vri73uSsKHnOAQnFrWWUctaJWrlSicZwZJV1lpaAGVFVKxoraMtE2QhSSAaV1xdp0txTn2ddtbmd6Pft0kH_Wk0F9fbnXq5acUXVN5QNL7JeNnf10v0CIesDgoO_NCMkozSsuaMFLVSW02FDnpxA8tK-zGdVrTvqot5z0mpPeckptn182LHaA5rXpXzAJ-LYBkDx5QPA6uOS8gyZZ66JuJvz_hr_mqKd3</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Boumaza, Xavier</creator><creator>Lafaurie, Margaux</creator><creator>Treiner, Emmanuel</creator><creator>Walter, Ondine</creator><creator>Pugnet, Gregory</creator><creator>Martin-Blondel, Guillaume</creator><creator>Biotti, Damien</creator><creator>Ciron, Jonathan</creator><creator>Constantin, Arnaud</creator><creator>Tauber, Marie</creator><creator>Puisset, Florent</creator><creator>Moulis, Guillaume</creator><creator>Alric, Laurent</creator><creator>Renaudineau, Yves</creator><creator>Chauveau, Dominique</creator><creator>Sailler, Laurent</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0003-0569-629X</orcidid><orcidid>https://orcid.org/0000-0002-3386-6308</orcidid><orcidid>https://orcid.org/0000-0001-6249-4534</orcidid><orcidid>https://orcid.org/0000-0001-7618-3585</orcidid><orcidid>https://orcid.org/0000-0002-8363-7028</orcidid></search><sort><creationdate>202307</creationdate><title>Infectious risk when prescribing rituximab in patients with hypogammaglobulinemia acquired in the setting of autoimmune diseases</title><author>Boumaza, Xavier ; 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We conducted a single-centre retrospective cohort study in a French University Hospital between 2010 and 2018 to describe the risk of severe infectious event (SIE) within 2 years after the date of first rituximab infusion (T0) prescribed after the evidence of acquired hypogammaglobulinemia (gamma globulins [GG] ≤ 6 g/L) in the setting of autoimmune diseases (AID) other than rheumatoid arthritis. SIE occurred in 26 out of 121 included patients. Two years cumulative incidence rates were 12.7 % (95 % CI 5.1–23.9) in the multiple sclerosis/neuromyelitis optica spectrum disorder group (n = 48), 27.6 % (95 % CI 15.7–40.9) in the ANCA-associated vasculitis group (n = 48) and 30.6 % (95 % CI 13.1–50.3) in the ‘other AID’ group (n = 25). Median GG level at T0 was 5.3 g/l (IQR 4.1–5.6) in the 'SIE' group and 5.6 g/l (IQR 4.7–5.8) in the 'no SIE' group (p = 0.04).
In regression analysis, risk of SIE increased with Charlson comorbidity index ≥ 3 (OR 2.77; 95 % CI 1.01–7.57), lung disease (OR 3.20; 95 % CI 1.27–7.99), GG < 4 g/L (OR 3.39; 95 % CI 1.02–11.19), concomitant corticosteroid therapy (OR 4.13; 95 % CI 1.63–10.44), previous cyclophosphamide exposure (OR 2.69; 95 % CI 1.10–6.61), a lymphocyte count < 1000 cells/µL (OR 2.86; 95 % CI 1.12–7.21) and absence of pneumococcal vaccination (OR 3.50; 95 % CI 1.41–8.70).
These results may help to inform clinical decision when considering a treatment by rituximab in immunosuppressed AID patients with hypogammaglobulinemia.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>37276827</pmid><doi>10.1016/j.intimp.2023.110342</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-0569-629X</orcidid><orcidid>https://orcid.org/0000-0002-3386-6308</orcidid><orcidid>https://orcid.org/0000-0001-6249-4534</orcidid><orcidid>https://orcid.org/0000-0001-7618-3585</orcidid><orcidid>https://orcid.org/0000-0002-8363-7028</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | International immunopharmacology, 2023-07, Vol.120, p.110342-110342, Article 110342 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Agammaglobulinemia - chemically induced Agammaglobulinemia - drug therapy Agammaglobulinemia - epidemiology Arthritis, Rheumatoid - drug therapy Autoimmune Diseases - chemically induced Autoimmune Diseases - drug therapy Humans Hypogammaglobulinemia Infections - chemically induced Infectious risk Life Sciences Retrospective Studies Rituximab Rituximab - adverse effects |
| title | Infectious risk when prescribing rituximab in patients with hypogammaglobulinemia acquired in the setting of autoimmune diseases |
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