Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated vasculitides receiving rituximab: A meta-analysis

Thery-Casari, C.; Euvrard, Romain; Mainbourg, Sabine; Durupt, S.; Reynaud, Quitterie; Durieu, I.; Belot, Alexandre; Lobbes, Hervé; Cabrera, Natalia; Lega, Jean‐Christophe

doi:10.1016/j.autrev.2020.102505

Cited by 39 publications

(23 citation statements)

References 75 publications

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“…Some such patients may respond to corticosteroid therapy and others only to rituximab. With regards to rituximab, for which the efficacy has also been described in CIDP without paranodal antibodies, 35 and while randomized controlled trial evidence is awaited, 36 the risk of infection may be heightened with cumulative dose (4% with every 100 mg) and reduced with time from administration (9% per year) 37 . Those already treated with rituximab, therefore, should be considered to be at high‐risk.…”

Section: Therapeutic Considerationsmentioning

confidence: 99%

“…With regards to rituximab, for which the efficacy has also been described in CIDP without paranodal antibodies, 35 and while randomized controlled trial evidence is awaited, 36 the risk of infection may be heightened with cumulative dose (4% with every 100 mg) and reduced with time from administration (9% per year). 37 Those already treated with rituximab, therefore, should be considered to be at highrisk. Clinical severity should be the sole driver of therapeutic decisions after greater persistence than previously with first-line agents, such as immunoglobulins (to which some patients with antiparanodal antibodies may also respond), plasma exchange, and, when essential, corticosteroids, and with clear information of risks being provided to patients and families.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%

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Management challenges for chronic dysimmune neuropathies during the COVID‐19 pandemic

et al. 2020

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Since March 2020, the COVID‐19 pandemic has led to the need to re‐think the delivery of services to patients with chronic dysimmune neuropathies. Telephone/video consultations have become widespread but have compounded concerns about objective evaluation. Therapeutic decisions need, more than ever before, to be considered in the best interests of both patients, and society, while not denying function‐preserving/restoring treatment. Immunoglobulin therapy and plasma exchange, for those treated outside of the home, expose patients to the hazards of hospital or outpatient infusion centers. Steroid therapy initiation and continuation pose increased infectious risk. Immunosuppressant therapy similarly becomes highly problematic, with the risks of treatment continuation enhanced by uncertainties regarding duration of the pandemic. The required processes necessitate considerable time and effort especially as resources and staff are re‐deployed to face the pandemic, but are essential for protecting this group of patients and as an integral part of wider public health actions.

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Section: Therapeutic Considerationsmentioning

confidence: 99%

Section: Diagnostic Considerationsmentioning

confidence: 99%

Management challenges for chronic dysimmune neuropathies during the COVID‐19 pandemic

et al. 2020

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“…For individuals without HIV infection, immunosuppressive therapies are the main cause of low immunity and the subsequent PJP occurs (5,6). Previous studies have reported that patients with autoimmune diseases and organ transplantation are the main users of immunosuppressive agents, and these patients are at high risk of PJP due to the status of treatment-related immunosuppression (7)(8)(9). Furthermore, absolute peripheral lymphopenia, high doses of corticosteroids with or without combination of other immunosuppressive agents, and concomitant lung disease are strong predictors for the development of PJP, and thus should warrant primary prophylaxis (10).…”

Section: Introductionmentioning

confidence: 99%

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Tang

Tong

et al. 2021

Front. Immunol.

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BackgroundPneumocystis jiroveci pneumonia (PJP) is the most common opportunistic infection in immunocompromised patients. The accurate prediction of PJP development in patients undergoing immunosuppressive therapy remains challenge.MethodsPatients undergoing immunosuppressive treatment and with confirmed pneumocystis jiroveci infection were enrolled. Another group of matched patients with immunosuppressant treatment but without signs of infectious diseases were enrolled to control group.ResultsA total of 80 (40 PJP, 40 non-PJP) participants were enrolled from Tongji Hospital. None of the patients were HIV positive. The routine laboratory indicators, such as LYM, MON, RBC, TP, and ALB, were significantly lower in PJP patients than in non-PJP patients. Conversely, LDH in PJP patients was significantly higher than in non-PJP controls. For immunological indicators, the numbers of T, B, and NK cells were all remarkably lower in PJP patients than in non-PJP controls, whereas the functional markers such as HLA-DR, CD45RO and CD28 expressed on CD4+ or CD8+ T cells had no statistical difference between these two groups. Cluster analysis showing that decrease of host immunity markers including CD3+, CD4+ and CD8+ T cells, and increase of tissue damage marker LDH were the most typical characteristics of PJP patients. A further established model based on combination of CD8+ T cells and LDH showed prominent value in distinguishing PJP from non-PJP, with AUC of 0.941 (95% CI, 0.892-0.990).ConclusionsA model based on combination of routine laboratory and immunological indicators shows prominent value for predicting the development of PJP in HIV-negative patients undergoing immunosuppressive therapy.

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“…This data are consistent with other studies. Trivin et al reported renal failure as a risk factor for infection events in patients treated with RTX due to various glomerular diseases [13]. However, the threshold of eGFR was at a level of 45 mL/min/1.73 m 2 .…”

Section: Discussionmentioning

confidence: 99%

“…The infection rate after RTX therapy depends on the disease, which provides an indication for this kind of treatment, and ranges between 1.9 per 100 patient-years for rheumatoid arthritis, and 16.6 per 100 patient-years for lupus erythematous [11,12]. A recently published meta-analysis, which described serious infectious complications after RTX treatment in AAV, reported an incidence rate of 6.5 per 100 patient-years [13]. In this study, the risk factor for the development of these complications was a cumulative dose of RTX.…”

Section: Introductionmentioning

confidence: 99%

Impaired Kidney Function Associated with Increased Risk of Side Effects in Patients with Small Vessel Vasculitis Treated with Rituximab as an Induction Therapy

Rymarz

Matyjek

Sułek-Jakóbczyk

et al. 2021

JCM

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Rituximab (RTX), a monoclonal antibody against the CD20 molecule, is used as an induction therapy in the treatment of small vessel vasculitis (SVV). The aim of the study was to evaluate the efficacy and safety of RTX induction therapy for refractory SVV. A retrospective analysis of 20 patients treated with RTX for active SVV (BVAS/WG ≥ 3) was performed to assess the remission rate and the drug-related severe adverse events 6 months after therapy. The mean age of the studied population was 49 ± 13 years (50% female), 90% of which were PR3-ANCA positive. Complete remission was achieved in 85% of patients, and partial remission was achieved in a further 10% within 6 months after RTX infusions. The remission rate was not influenced by kidney function. Adverse events such as infections (25%), a late onset of neutropenia (10%) and severe hypogammaglobulinemia (5%) were noted. The patients who developed adverse events were older (42 ± 11 vs. 57 ± 12 years; p = 0.014) and had a higher serum creatinine level (1.3 mg/dL vs. 3.35 mg/dL; p = 0.044). Patients with a glomerular filtration rate (eGFR) lower than 30 mL/min/1.73 m2 had a nine-fold higher risk of side effects (OR 9.0, 95%CI: 1.14–71.0). In conclusion, RTX was highly effective as an induction therapy in patients with SVV. Advanced kidney failure with an eGFR lower than 30 mL/min/1.73 m2 was one of the risk factors for the occurrence of side effects.

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Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated vasculitides receiving rituximab: A meta-analysis

Cited by 39 publications

References 75 publications

Management challenges for chronic dysimmune neuropathies during the COVID‐19 pandemic

Management challenges for chronic dysimmune neuropathies during the COVID‐19 pandemic

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Impaired Kidney Function Associated with Increased Risk of Side Effects in Patients with Small Vessel Vasculitis Treated with Rituximab as an Induction Therapy

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