Predictors of hypogammaglobulinemia during rituximab maintenance therapy in rheumatoid arthritis: A 12-year longitudinal multi-center study

Long‐term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP‐ritux

“…This incidence rate is in the lower range of the severe infections rate observed in other autoimmune diseases treated with rituximab and particularly in large cohorts of patients with RA (1.5-7.9/100 patient-years). 17,[25][26][27][28][29][30] Chronic ITP could be associated itself with an increased risk of serious infections, with an SIR of 8.74 (95% CI, 7.47-10.18). 31 So, the relation between the incidence of severe infections we observed and the use of rituximab is questionable, because most of our patients with severe infection had comorbidities or received prolonged treatment with steroids or immu- depletion secondary to the use of rituximab, it is not a surprise that the incidence of severe infections we observed was higher during the first year, when B-cell depression induced by rituximab is substantial, with one third of infections seen.…”

“…50,54,55 Another option could be to repeat rituximab infusion as maintenance therapy, as commonly done in other autoimmune diseases such as RA or ANCA-associated vasculitis. 17,18 However, we have only few data in the literature assessing the efficacy and safety of repeated infusions of rituximab in ITP patients, and maintenance treatment has never been prospectively tested. In our study, among the 26 evaluable patients with retreatment, the second course allowed for a response in more than 80%, with a higher duration of response in more than half.…”

“…This is because rituximab is frequently associated with long-term steroids, or another immunosuppressive therapy and/or is given repeatedly in these diseases. 17,18 The last important issue is the efficacy of retreatment for patients who initially respond to a first course of rituximab. Other autoimmune diseases exhibit high risk of relapse, for which maintenance treatment is used by most groups.…”

“…3.2.6 | Hypogammaglobulinemia and neutropeniaGammaglobulin level was not systematically monitored. Among the 142 (52%) patients with available data, five with median age 49 years[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] showed profound hypogammaglobulinemia (<5 g/L) after a median of 25[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] months after the last rituximab infusion. The median lowest gammaglobulin level in these five patients was 3.12…”

Predicting Severe Infection and Effects of Hypogammaglobulinemia During Therapy With Rituximab in Rheumatic and Musculoskeletal Diseases

“…However, attrition of immunoglobulin levels may occur . Data from a registry and a small number of observational studies showed that low gamma globulin (IgG) before RTX treatment increased the odds of serious infection events (SIEs) in the initial 12 months of follow‐up after RTX treatment was started . Nevertheless, predictors of SIEs during repeat cycles have not been reported.…”