The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease
Rituximab is a B cell depleting anti-CD20 monoclonal antibody. CD20 is not expressed on mature plasma cells and accordingly rituximab does not have immediate effects on immunoglobulin levels. However, after rituximab some patients develop hypogammaglobulinaemia. We performed a single centre retrospe...
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| Veröffentlicht in: | BMC musculoskeletal disorders 2014-05, Vol.15 (1), p.178-178, Article 178 |
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| creator | Marco, Helena Smith, Rona M Jones, Rachel B Guerry, Mary-Jane Catapano, Fausta Burns, Stella Chaudhry, Afzal N Smith, Kenneth G C Jayne, David R W |
| description | Rituximab is a B cell depleting anti-CD20 monoclonal antibody. CD20 is not expressed on mature plasma cells and accordingly rituximab does not have immediate effects on immunoglobulin levels. However, after rituximab some patients develop hypogammaglobulinaemia.
We performed a single centre retrospective review of 177 patients with multisystem autoimmune disease receiving rituximab between 2002 and 2010. The incidence, severity and complications of hypogammaglobulinaemia were investigated.
Median rituximab dose was 6 g (1-20.2) and total follow-up was 8012 patient-months. At first rituximab, the proportion of patients with IgG |
| doi_str_mv | 10.1186/1471-2474-15-178 |
| format | Article |
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We performed a single centre retrospective review of 177 patients with multisystem autoimmune disease receiving rituximab between 2002 and 2010. The incidence, severity and complications of hypogammaglobulinaemia were investigated.
Median rituximab dose was 6 g (1-20.2) and total follow-up was 8012 patient-months. At first rituximab, the proportion of patients with IgG <6 g/L was 13% and remained stable at 17% at 24 months and 14% at 60 months. Following rituximab, 61/177 patients (34%) had IgG <6 g/L for at least three consecutive months, of whom 7/177 (4%) had IgG <3 g/L. Low immunoglobulin levels were associated with higher glucocorticoid doses during follow up and there was a trend for median IgG levels to fall after ≥ 6 g rituximab. 45/115 (39%) with IgG ≥ 6 g/L versus 26/62 (42%) with IgG <6 g/L experienced severe infections (p=0.750). 6/177 patients (3%) received intravenous immunoglobulin replacement therapy, all with IgG <5 g/L and recurrent infection.
In multi-system autoimmune disease, prior cyclophosphamide exposure and glucocorticoid therapy but not cumulative rituximab dose was associated with an increased incidence of hypogammaglobulinaemia. Severe infections were common but were not associated with immunoglobulin levels. Repeat dose rituximab therapy appears safe with judicious monitoring.</description><identifier>ISSN: 1471-2474</identifier><identifier>EISSN: 1471-2474</identifier><identifier>DOI: 10.1186/1471-2474-15-178</identifier><identifier>PMID: 24884562</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adolescent ; Adult ; Agammaglobulinemia - blood ; Agammaglobulinemia - chemically induced ; Agammaglobulinemia - diagnosis ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Murine-Derived - adverse effects ; Antibodies, Monoclonal, Murine-Derived - therapeutic use ; Autoimmune diseases ; Autoimmune Diseases - blood ; Autoimmune Diseases - diagnosis ; Autoimmune Diseases - drug therapy ; Care and treatment ; Complications and side effects ; Drug therapy ; Female ; Follow-Up Studies ; Humans ; Immune system ; Immunoglobulins - blood ; Immunologic Factors - adverse effects ; Immunologic Factors - therapeutic use ; Lupus ; Lymphoma ; Male ; Measurement ; Middle Aged ; Retrospective Studies ; Rituximab ; Treatment Outcome ; Young Adult</subject><ispartof>BMC musculoskeletal disorders, 2014-05, Vol.15 (1), p.178-178, Article 178</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>2014 Marco et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Copyright © 2014 Marco et al.; licensee BioMed Central Ltd. 2014 Marco et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b584t-2212daa574afd50400801d8748db66946c953e75385cf069c8e1768b18cbca753</citedby><cites>FETCH-LOGICAL-b584t-2212daa574afd50400801d8748db66946c953e75385cf069c8e1768b18cbca753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038057/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038057/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24884562$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marco, Helena</creatorcontrib><creatorcontrib>Smith, Rona M</creatorcontrib><creatorcontrib>Jones, Rachel B</creatorcontrib><creatorcontrib>Guerry, Mary-Jane</creatorcontrib><creatorcontrib>Catapano, Fausta</creatorcontrib><creatorcontrib>Burns, Stella</creatorcontrib><creatorcontrib>Chaudhry, Afzal N</creatorcontrib><creatorcontrib>Smith, Kenneth G C</creatorcontrib><creatorcontrib>Jayne, David R W</creatorcontrib><title>The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease</title><title>BMC musculoskeletal disorders</title><addtitle>BMC Musculoskelet Disord</addtitle><description>Rituximab is a B cell depleting anti-CD20 monoclonal antibody. CD20 is not expressed on mature plasma cells and accordingly rituximab does not have immediate effects on immunoglobulin levels. However, after rituximab some patients develop hypogammaglobulinaemia.
We performed a single centre retrospective review of 177 patients with multisystem autoimmune disease receiving rituximab between 2002 and 2010. The incidence, severity and complications of hypogammaglobulinaemia were investigated.
Median rituximab dose was 6 g (1-20.2) and total follow-up was 8012 patient-months. At first rituximab, the proportion of patients with IgG <6 g/L was 13% and remained stable at 17% at 24 months and 14% at 60 months. Following rituximab, 61/177 patients (34%) had IgG <6 g/L for at least three consecutive months, of whom 7/177 (4%) had IgG <3 g/L. Low immunoglobulin levels were associated with higher glucocorticoid doses during follow up and there was a trend for median IgG levels to fall after ≥ 6 g rituximab. 45/115 (39%) with IgG ≥ 6 g/L versus 26/62 (42%) with IgG <6 g/L experienced severe infections (p=0.750). 6/177 patients (3%) received intravenous immunoglobulin replacement therapy, all with IgG <5 g/L and recurrent infection.
In multi-system autoimmune disease, prior cyclophosphamide exposure and glucocorticoid therapy but not cumulative rituximab dose was associated with an increased incidence of hypogammaglobulinaemia. Severe infections were common but were not associated with immunoglobulin levels. Repeat dose rituximab therapy appears safe with judicious monitoring.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Agammaglobulinemia - blood</subject><subject>Agammaglobulinemia - chemically induced</subject><subject>Agammaglobulinemia - diagnosis</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibodies, Monoclonal, Murine-Derived - adverse effects</subject><subject>Antibodies, Monoclonal, Murine-Derived - therapeutic use</subject><subject>Autoimmune diseases</subject><subject>Autoimmune Diseases - blood</subject><subject>Autoimmune Diseases - diagnosis</subject><subject>Autoimmune Diseases - drug therapy</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Immune system</subject><subject>Immunoglobulins - blood</subject><subject>Immunologic Factors - adverse effects</subject><subject>Immunologic Factors - therapeutic use</subject><subject>Lupus</subject><subject>Lymphoma</subject><subject>Male</subject><subject>Measurement</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Rituximab</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1471-2474</issn><issn>1471-2474</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kk1v3CAQhlHVqkm3vfdUIfWSi1MwYPClUrRKP6RIuaRnhPF4TYTN1uCk---Lu-k2G6XiAJp55mXm1SD0npJzSlX1iXJJi5JLXlBRUKleoNND6OWj9wl6E-MtIRlh9Wt0UnKluKjKU9Tf9ICh68AmHDo8uTT_coNpcOphMtsdDiN2wzCPYeNDM3s3Yg934CPOr61JDsYU8b1LPR5mn1zcxQQDNnMKf8oAty6CifAWveqMj_Du4V6hH18ub9bfiqvrr9_XF1dFIxRPRVnSsjVGSG66VhBOiCK0VZKrtqmqmle2FgykYErYjlS1VUBlpRqqbGNNjq_Q573udm4GaG3ubzJeb6c81bTTwTh9nBldrzfhTnPCFBEyC6z3Ao0L_xE4ztgw6MVpvTitqdCLyyt09tDGFH7OEJMeXLTgvRkhzDFjnJSME8Uy-vEJehvmacwmZYpJVleilv-ojfGg3diF_LldRPWFyExZSUYzdf4MlU8Lg7NhhM7l-FEB2RfYKcQ4QXcYlBK97Nhzo3147PCh4O9Ssd-oQM0j</recordid><startdate>20140525</startdate><enddate>20140525</enddate><creator>Marco, Helena</creator><creator>Smith, Rona M</creator><creator>Jones, Rachel B</creator><creator>Guerry, Mary-Jane</creator><creator>Catapano, Fausta</creator><creator>Burns, Stella</creator><creator>Chaudhry, Afzal N</creator><creator>Smith, Kenneth G C</creator><creator>Jayne, David R W</creator><general>BioMed Central Ltd</general><general>BioMed Central</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>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7T5</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>20140525</creationdate><title>The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease</title><author>Marco, Helena ; Smith, Rona M ; Jones, Rachel B ; Guerry, Mary-Jane ; Catapano, Fausta ; Burns, Stella ; Chaudhry, Afzal N ; Smith, Kenneth G C ; Jayne, David R W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b584t-2212daa574afd50400801d8748db66946c953e75385cf069c8e1768b18cbca753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Agammaglobulinemia - blood</topic><topic>Agammaglobulinemia - chemically induced</topic><topic>Agammaglobulinemia - diagnosis</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibodies, Monoclonal, Murine-Derived - adverse effects</topic><topic>Antibodies, Monoclonal, Murine-Derived - therapeutic use</topic><topic>Autoimmune diseases</topic><topic>Autoimmune Diseases - blood</topic><topic>Autoimmune Diseases - diagnosis</topic><topic>Autoimmune Diseases - drug therapy</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Immune system</topic><topic>Immunoglobulins - blood</topic><topic>Immunologic Factors - adverse effects</topic><topic>Immunologic Factors - therapeutic use</topic><topic>Lupus</topic><topic>Lymphoma</topic><topic>Male</topic><topic>Measurement</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Rituximab</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marco, Helena</creatorcontrib><creatorcontrib>Smith, Rona M</creatorcontrib><creatorcontrib>Jones, Rachel B</creatorcontrib><creatorcontrib>Guerry, Mary-Jane</creatorcontrib><creatorcontrib>Catapano, Fausta</creatorcontrib><creatorcontrib>Burns, Stella</creatorcontrib><creatorcontrib>Chaudhry, Afzal N</creatorcontrib><creatorcontrib>Smith, Kenneth G C</creatorcontrib><creatorcontrib>Jayne, David R W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC musculoskeletal disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marco, Helena</au><au>Smith, Rona M</au><au>Jones, Rachel B</au><au>Guerry, Mary-Jane</au><au>Catapano, Fausta</au><au>Burns, Stella</au><au>Chaudhry, Afzal N</au><au>Smith, Kenneth G C</au><au>Jayne, David R W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease</atitle><jtitle>BMC musculoskeletal disorders</jtitle><addtitle>BMC Musculoskelet Disord</addtitle><date>2014-05-25</date><risdate>2014</risdate><volume>15</volume><issue>1</issue><spage>178</spage><epage>178</epage><pages>178-178</pages><artnum>178</artnum><issn>1471-2474</issn><eissn>1471-2474</eissn><abstract>Rituximab is a B cell depleting anti-CD20 monoclonal antibody. CD20 is not expressed on mature plasma cells and accordingly rituximab does not have immediate effects on immunoglobulin levels. However, after rituximab some patients develop hypogammaglobulinaemia.
We performed a single centre retrospective review of 177 patients with multisystem autoimmune disease receiving rituximab between 2002 and 2010. The incidence, severity and complications of hypogammaglobulinaemia were investigated.
Median rituximab dose was 6 g (1-20.2) and total follow-up was 8012 patient-months. At first rituximab, the proportion of patients with IgG <6 g/L was 13% and remained stable at 17% at 24 months and 14% at 60 months. Following rituximab, 61/177 patients (34%) had IgG <6 g/L for at least three consecutive months, of whom 7/177 (4%) had IgG <3 g/L. Low immunoglobulin levels were associated with higher glucocorticoid doses during follow up and there was a trend for median IgG levels to fall after ≥ 6 g rituximab. 45/115 (39%) with IgG ≥ 6 g/L versus 26/62 (42%) with IgG <6 g/L experienced severe infections (p=0.750). 6/177 patients (3%) received intravenous immunoglobulin replacement therapy, all with IgG <5 g/L and recurrent infection.
In multi-system autoimmune disease, prior cyclophosphamide exposure and glucocorticoid therapy but not cumulative rituximab dose was associated with an increased incidence of hypogammaglobulinaemia. Severe infections were common but were not associated with immunoglobulin levels. Repeat dose rituximab therapy appears safe with judicious monitoring.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24884562</pmid><doi>10.1186/1471-2474-15-178</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC musculoskeletal disorders, 2014-05, Vol.15 (1), p.178-178, Article 178 |
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| source | Springer Open Access; MEDLINE; PubMed Central; Directory of Open Access Journals; EZB Electronic Journals Library; SpringerLink Journals - AutoHoldings; PubMed Central Open Access |
| subjects | Adolescent Adult Agammaglobulinemia - blood Agammaglobulinemia - chemically induced Agammaglobulinemia - diagnosis Aged Aged, 80 and over Antibodies, Monoclonal, Murine-Derived - adverse effects Antibodies, Monoclonal, Murine-Derived - therapeutic use Autoimmune diseases Autoimmune Diseases - blood Autoimmune Diseases - diagnosis Autoimmune Diseases - drug therapy Care and treatment Complications and side effects Drug therapy Female Follow-Up Studies Humans Immune system Immunoglobulins - blood Immunologic Factors - adverse effects Immunologic Factors - therapeutic use Lupus Lymphoma Male Measurement Middle Aged Retrospective Studies Rituximab Treatment Outcome Young Adult |
| title | The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease |
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