Abstract
BackgroundRandomized controlled trials and retrospective studies in ANCA-associated vasculitis (AAV) concurred that rituximab (RTX) is effective to induce and maintain remission. Infections and hypogammaglobulinemia during RTX were usually infrequent and uncomplicated. But in the Tromsø study cohort, 45 % of patients with granulomatosis with polyangiitis (GPA) developed hypogammaglobulinemia during RTX maintenance leading to its discontinuation in 62 %.MethodsTo explain these differences in outcome when using RTX in AAV to maintain remission, we used statistical structural methods to compare the Tromsø study cohort with other published cohorts.ResultsGPA patients’ characteristics of the Tromsø study cohort were not so different compared with other cohorts. Rates of hypogammaglobulinemia and discontinuation of RTX seemed closely related to the cut-off used and to the levels of immunoglobulin (Ig) at baseline. Combination of low IgG serum levels at baseline (7.7 g/L) and low cut-off to define hypogammaglobulinemia in the Tromsø study cohort explained the high rate of hypogammaglobulinemia and discontinuation of RTX.ConclusionsPatients’ characteristics in the Tromsø study cohort were not skewed, apart from IgG levels. Low IgG level at baseline seemed to contribute the most to hypogammaglobulinemia and its complications.
Highlights
Randomized controlled trials and retrospective studies in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) concurred that rituximab (RTX) is effective to induce and maintain remission
granulomatosis with polyangiitis (GPA) patients’ characteristics of the Tromsø study cohort were not so different compared with other cohorts
Rates of hypogammaglobulinemia and discontinuation of RTX seemed closely related to the cut-off used and to the levels of immunoglobulin (Ig) at baseline
Summary
Randomized controlled trials and retrospective studies in ANCA-associated vasculitis (AAV) concurred that rituximab (RTX) is effective to induce and maintain remission. In the Tromsø study cohort, 45 % of patients with granulomatosis with polyangiitis (GPA) developed hypogammaglobulinemia during RTX maintenance leading to its discontinuation in 62 %. Granulomatosis with polyangiitis (GPA) is an ANCAassociated vasculitis (AAV) affecting usually the small and medium vessels and is closely related to proteinase3ANCA (PR3-ANCA). Rituximab (RTX) is a chimeric monoclonal antibody against CD20 that depletes B cells [2] and is effective in inducing and maintaining remission in AAV patients in randomized controlled studies [3,4,5]. In the Tromsø study cohort, 17 % received intravenous immunoglobulin (IVIG) replacement and 62 % who developed hypogammaglobulinemia discontinued maintenance remission with RTX [8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
