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Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study
Univ Milan, Italy; Harvard Med Sch, MA 02115 USA.
ASST Spedali Civili, Italy; ASST Spedali Civili, Italy; Univ Brescia, Italy.
Univ Milan, Italy.
Univ Cambridge, England.
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2023 (English)In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 62, no 8, p. 2850-2854Article in journal (Refereed) Published
Abstract [en]

Objectives Rituximab has become the cornerstone of induction treatment in ANCA-associated vasculitis (AAV). B-cell depletion may increase the risk of hypogammaglobulinemia, potentially leading to severe infections. This study aims to assess factors associated with hypogammaglobulinemia in AAV patients treated with rituximab. Methods This retrospective cohort study included AAV patients treated with rituximab induction in 14 European centres. Severe adverse events (SAEs) were defined as episodes requiring hospitalization or intravenous antibiotics, malignancies, or death. Linear and logistic regression were used to identify predictors of IgG levels and of the risk of hypogammaglobulinemia, defined as IgG <= 7 g/l at 6 months. Results The study included 227 patients. IgG levels at 6 months were lower than baseline (P < 0.001). Patients requiring intravenous antibiotics during the first 6 months had lower IgG levels at 6 months (P = 0.004). Age [beta (95% CI): -0.23 (-0.38, -0.08) per 10 years, P = 0.003], oral glucocorticoid dose at induction [beta (95% CI): -0.37 (-0.51, -0.24) per sqrt-transformed mg prednisone, P < 0.001] and concomitant use of intravenous glucocorticoid pulses [beta (95% CI): -0.88 (-1.73, -0.02), P = 0.044] were associated with IgG levels at 6 months. Hypogammaglobulinemia was identified in 97 (42.7%) patients. In multivariable logistic regression, factors associated with the risk of hypogammaglobulinemia were age [OR (95% CI): 1.46 (1.15, 1.86) per 10 years, P = 0.002] and oral glucocorticoid dose at induction [OR (95% CI): 1.52 (1.23, 1.89) per 10 mg prednisone, P < 0.001]. Conclusions In AAV patients treated with rituximab, hypogammaglobulinemia at 6 months after induction is common, and lower IgG levels are associated with serious infections. The risk of hypogammaglobulinemia in these patients increases with age and higher glucocorticoid doses.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2023. Vol. 62, no 8, p. 2850-2854
Keywords [en]
ANCA-associated vasculitis; rituximab; glucocorticoids; immunosuppression; cyclophosphamide; immunoglobulins; hypogammaglobulinemia; severe adverse events; severe infections; retrospective study
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Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-191384DOI: 10.1093/rheumatology/keac716ISI: 000908457800001PubMedID: 36562566OAI: oai:DiVA.org:liu-191384DiVA, id: diva2:1733144
Available from: 2023-02-01 Created: 2023-02-01 Last updated: 2025-02-18Bibliographically approved

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Bruchfeld, Annette

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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Nephrology
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