Immunoglobulin Levels In Patients Research Articles

Complex evaluation of serum immunoglobulin levels in patients with chronic lymphocytic leukemia: Significant increase in IgA after first-line chemoimmunotherapy.

The impact of chemoimmunotherapy (CIT) on immunoglobulin (Ig) quantities in patients with chronic lymphocytic leukemia (CLL) has not been extensively studied. We analyzed Ig levels in 45 stable patients with indolent CLL (without indication for treatment) and 87 patients with progressive disease before first-line treatment. Fifty-five patients were evaluated again after the treatment with CIT. We observed significantly lower levels of all Ig classes and subclasses in patients with progressive disease compared to patients with indolent disease. After treatment, median IgA increased from 0.59 g/L to 0.74 g/L (p = 0.0031). In stable patients, lower IgA2 was associated with shorter time to first treatment, although it did not reach statistical significance (p = 0.056). Shorter overall survival was observed in patients with progressive disease and lower IgG2 (p = 0.043). Surprisingly, among the patients with progressive CLL, unmutated IGHV genes were associated with higher levels of IgG, IgG1 and IgM, while TP53 mutation and/or 17p deletion were associated with higher levels of IgA and IgA1. CIT may lead to increase in IgA levels. Hypogammaglobulinemia is more common in patients with progressive CLL and unmutated IGHV or TP53 dysfunction.

IgA nephropathy in a child with X-linked agammaglobulinemia: a case report

BackgroundX-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease caused by mutations in the Bruton tyrosine kinase (BTK) gene. Individuals diagnosed with XLA are at an increased risk of developing autoimmune diseases. However, renal involvement are rare in cases of XLA.Case presentationIn this report, we discussed a specific case involving a 6-year-old boy with XLA who experienced recurrent upper respiratory tract infections since the age of one. He presented with symptoms of hematuria and proteinuria, and renal pathology confirmed the presence of immunoglobulin (Ig) A nephropathy. Treatment comprised glucocorticoids, mycophenolate mofetil, and intermittent intravenous immunoglobulin replacement therapy. Consequently, there was a remission of proteinuria and a partial improvement in hematuria.ConclusionsIn this study, we describe the first case of IgA nephropathy associated with XLA. This is an interesting phenotype found in XLA, and it provides valuable insights into the process of autoimmunity and the regulation of immune function in individuals with XLA. Based on our findings, we recommend the evaluation of immunoglobulin levels in patients diagnosed with IgA nephropathy.

E005 Immunoglobulins review prior to rituximab infusion: implications and how we can improve our service

Abstract Background/Aims Rituximab (RTX), used in the treatment of autoimmune and lymphoproliferative diseases, depletes B-cells through anti-CD20. The resulting hypogammaglobulinemia increases susceptibility to recurrent or severe infections, however the absence of a protocolised approach to measuring serum immunoglobulin levels prior to, or between, RTX infusions in our infusion unit has led to cancelled treatments, and even delivery of treatments without a timely record of immunoglobulin levels. British Society for Rheumatology guidelines recommend checking immunoglobulin levels prior to treatment, then four to six months after infusions and before any future cycles of treatment. Our aim was to optimise monitoring standards of immunoglobulin levels in patients receiving RTX infusions, thereby minimising avoidable harm and unnecessary treatment cancellations. Methods Data was collected retrospectively using electronic patient records. The analysis included sixty patients with rheumatological conditions scheduled for RTX infusions during a three-month period. Results Treatment was appropriately withheld in six patients without up-to-date immunoglobulin levels, and in one patient with active infection. However, RTX was given in 28% (17 out of 60) of patients without up-to-date immunoglobulin levels; the mean duration of time between the current cycle of RTX treatment and most up-to-date prior immunoglobulin result being 179 days (median 109 days). Of note, this exceeded 200 days for 4 of these 17 patients (24%), and an absence of pre-RTX immunoglobulin levels was observed in a further 3 of these 17 patients (18%). Although no adverse events have occurred, this represents a compromise in patient safety. Whilst there is no definitive guidance on the reasonable maximum time limit between a RTX infusion and the most up-to-date immunoglobulin levels, a departmental consensus of one month was agreed upon through discussion and literature reviews. Robust measures have been taken, using a multi-disciplinary and multi-step approach, to achieve this:1. Patient list generated one week in advance for the clinical team to review pre-screening tests, including immunoglobulins. Any missing tests can be requested in advance of the infusion date.2. Pharmacy update of their checklist to include reviewing immunoglobulins results prior to dispensing Rituximab; escalating to the clinical team if missing or abnormal result.3. If the above measures have failed, a final safety net has been agreed by the multi-disciplinary team that bloods are taken and urgently processed in the laboratory, with RTX conditionally screened by pharmacy, to reduce treatment delay from appointment cancellation. Conclusion Next steps will be to develop this into a first cycle of quality improvement. This will involve measuring changes from comparing data points prior to and after implementation of the above changes. Furthermore, rates of post-RTX infections or complications of immunodeficiency will be measured before and after the interventions to determine the impact on patient safety and minimise avoidable harm and unnecessary treatment cancellations. Disclosure U. Kalluri: None. V. Thanopoulou: None. T. Malley: None.

Long-term Effect of Ofatumumab on Serum Immunoglobulin Levels in Patients with Relapsing Multiple Sclerosis (P9-6.007)

Long-term Effect of Ofatumumab on Serum Immunoglobulin Levels in Patients with Relapsing Multiple Sclerosis (P9-6.007)

Assessing serum cytokine and immunoglobulin levels in patients with allergic rhinitis and allergic rhinoconjunctivitis before and after treatment supplemented with macromycetes

Background: In recent decades, the prevalence of allergic rhinitis (AR) has been increasing all over the world including Ukraine. Allergic rhinoconjunctivitis (ARC) is one of the most common clinical forms of AR. An imbalance between pro-inflammatory and anti-inflammatory cytokines is known to have a key role in allergic inflammation. Purpose: To compare cytokine and immunoglobulin levels among patients with AR and ARC treated with different therapeutic options. Material and Methods: Forty patients with AR and ARC (age range, 20 to 46 years) were included in the study. Disease duration ranged from 6 months to 2 years. Patients were divided into two subgroups of 20 patients each. Patients of subgroup 1 received the basic therapy (a 10-mg loratadin tablet daily and mometasone furoate nasal spray at a dosage of 200 μg once daily), whereas patients of subgroup 2, the basic therapy plus polypore macromycetes (Astmagan), one capsule twice daily. Treatment course duration was 90 days. The control group was composed of 25 healthy individuals. A comprehensive clinical immunological examination was conducted at baseline and on the completion of the treatment course. Enzyme-linked immunosorbent assay kits were used to determine serum levels of immunoglobulins A (IgA), IgM, IgG, and IgE, and cytokines (gamma interferon (IFN-γ) and IL4). Results: At baseline, serum levels of IgA, IgM and IgE were almost twice as high (р = 0.0008; 0.0005; and 0.0001, respectively); IgG, 1.2 times higher (р = 0.001); pro-inflammatory cytokine IL4, 3.5 times higher (р = 0.0001); and anti-inflammatory cytokine IFN-γ, 2.4 times lower (р = 0.0001) in patients with AR and ARC compared to controls, and these differences were significant. Astmagan, when used as an adjunct to the basic treatment of AR and ARC, contributed to 8%, 17%, 16.2%, 7.3% and 6.0% greater decreases in the serum levels of IgA, IgM, IgE, IgG and IL4, respectively, and a 16.6% greater increase in the serum level of IFN-γ compared to the basic treatment only, and these differences were significant, with an improvement in immune response to therapy.

Effects of Different Nursing Modes on Immune Function and Renal Function in Patients with Renal Calculus Undergoing Percutaneous Nephrolithotomy.

This study aimed to explore the effects of different nursing modes on immune function and renal function in patients with renal calculus and on percutaneous nephrolithotomy (PCNL). A total of 160 patients with kidney stone who were admitted to our hospital from January 2017 to January 2023 were retrospectively selected and equally divided into routine and comprehensive nursing groups. Both groups were treated with percutaneous nephrolithotomy, but the patients in the routine nursing group were treated with usual care, whereas the patients in the comprehensive nursing group were treated with comprehensive nursing. The levels of serum T lymphocyte subsets were detected by flow cytometry, the levels of serum immune indicators and renal function indicators in the two groups were measured and the incidence of postoperative complications and nursing satisfaction were recorded. The levels of serum blood urea nitrogen, creatinine, kidney injury molecule and CD8+ cell subsets in the comprehensive nursing group were lower than those in the routine nursing group (p < 0.05), whereas the CD4+ cell subsets, CD4+:CD8+ ratio, and immunoglobulins (Ig)A, IgG and IgM levels were significantly higher than those in the routine nursing group (p < 0.05). The incidence of postoperative complications in the comprehensive nursing group was 2.50% (2/80), which was significantly lower than that in the routine nursing group (13.75%, 11/80), and the difference was statistically significant (χ2 = 6.782, p = 0.009). Nursing satisfaction in the comprehensive nursing group was 96.25% (77/80), which was significantly higher than that in the routine nursing group (85.00%, 68/80; χ2 = 5.959, p = 0.015). The comprehensive nursing mode can effectively reduce the influence of PCNL on T cell subsets, immunoglobulin levels in patients with renal calculus, damage to renal function and complications; Can improve patients' satisfaction with nursing; And promote postoperative recovery.

Randomized Phase II JANUS Study of Atacicept in Patients With IgA Nephropathy and Persistent Proteinuria

IntroductionPatients with IgA nephropathy (IgAN) and persistent proteinuria are at risk of progression to kidney failure. Atacicept is a novel B-cell–targeted immunomodulator, shown to reduce immunoglobulin levels in patients with autoimmune diseases.MethodsJANUS (NCT02808429) was a phase II study that assessed the safety, pharmacodynamic effects, and efficacy of atacicept in patients with IgAN and proteinuria ≥1 g/d or 0.75 mg/mg on 24-hour UPCR despite maximal standard of care therapy.ResultsA total of 16 patients were randomized 1:1:1 to placebo (n = 5), atacicept 25 mg (n = 6), or atacicept 75 mg (n = 5) once weekly using subcutaneous injection. Twelve (75%) completed ≥48 weeks of treatment; 8 (50%) completed 72 weeks of treatment and the 24-week safety follow-up period. Fourteen patients reported treatment-emergent adverse events (TEAEs). Most TEAEs were mild or moderate in severity. Three patients (placebo n = 1; atacicept 25 mg n = 2) reported serious TEAEs, none of which were treatment related. Dose-dependent reductions in IgA, IgG, IgM, and galactose-deficient (Gd)-IgA1 with atacicept at week 24 were maintained to week 72. Early reduction in proteinuria was observed at week 24 with atacicept. Renal function progressively declined with placebo but remained stable under exposure to atacicept.ConclusionAtacicept has an acceptable safety profile in patients with IgAN and is effective at reducing the levels of pathogenic factor Gd-IgA1, with potential improvements in proteinuria and renal function.

Comparative effects of clozapine and risperidone monotherapy on levels of immunoglobulins in patients with schizophrenia – A 12 weeks' longitudinal study

Background: Schizophrenia is among the most puzzling yet disabling of all brain diseases. The finding of immunity-related genes seems to vindicate theories about the involvement of neuroimmunological processes in the pathogenesis of schizophrenia. Moreover, antipsychotics used in the treatment of schizophrenia have been shown to have effects on serum immunoglobulin levels. Aim: The aim of this study was to assess and compare the effect of risperidone and clozapine on the immunoglobulins at 6 weeks and 12 weeks in patients with schizophrenia and its clinical correlation. Materials and Methods: It was an open-label, randomized, comparative, and prospective study. Patients with International Classification of Diseases-11th Revision diagnosis of schizophrenia who were not on any antipsychotic drug for more than 2 weeks, were randomized to two groups, i.e., A (risperidone) and B (clozapine) after baseline assessment of sociodemographic and clinical parameters on the Positive and Negative Syndrome Scale (PANSS). Baseline blood investigations (complete hemogram, liver and renal function tests, lipid profile, and fasting blood sugar) and immunoglobulin estimation were done. Patients were followed at 6 weeks and 12 weeks and levels of immunoglobulin were reassessed at 6 weeks and 12 weeks along with PANSS and Glasgow Antipsychotic Side-Effect checklist. Results: A total of 32 patients were inducted into the study – 16 in the risperidone group and 16 in the clozapine group. There was no statistically significant difference in terms of the duration of illness or period of exacerbation between the two groups though the baseline total PANSS score was significantly higher in the clozapine group. In both the groups, there was no statistically significant difference in the baseline immunoglobulin levels at baseline and over 12 weeks in terms of the immunoglobulin G (IgG), IgM, and IgE levels. Within the clozapine group, a significant difference over 12 weeks was noted in IgG level. Conclusion: It can be concluded from the index study that the immunoglobulin levels in the patients with schizophrenia do not differ much concerning the effect of risperidone and clozapine. Clozapine is associated with a significant increase in IgG levels indicating the immunologic response of clozapine in schizophrenia.

HUMORAL IMMUNE RESPONSE BEFORE AND AFTER SURGICAL THERAPY IN PATIENTS WITH ODONTOGENIC INFLAMMATORY CYSTS

Odontogenic inflammatory cysts are pathological lesions that are often represented in clinical practice and they presented potential focal points with an impact on other organs and systems in the body. The aim&nbsp;&nbsp;of this research is to compare the patients’ humoral immune response by verifying the level of immunoglobulins IgA, IgG and IgM in the serum before and one month after surgical therapy in patients with odontogenic inflammatory cysts.&nbsp;44 male and female patients diagnosed with odontogenic inflammatory cysts were included in the study and divided into three groups (Group 1-patients with radicular cysts-23, Group 2-patients with residual cysts-10 and, Group 3-patients with periodontal cysts-11). &nbsp;Тhe values ​​of IgA, IgM and IgG in serum werе examined before and one month after the surgical therapy in the device Cobas 6000 model c501 (Roche, Germany). In all three examined parameters of humoral immunity (IgA, IgG and IgM in serum), a significant difference was observed in the patients in addition to a decrease in their values ​​1 month after the surgical intervention compared to before the intervention. The level of IgA before and 1 month after intervention between the three groups of patients did not indicate a significant difference for a consequent p=0.2716 vs. p=0.2898. A significant difference between the three groups of patients, before and 1 month after the surgery, was also not found in terms of the IgG level for a consequent p=0.2692 vs. p=0.3614. The comparison of the three groups of patients regarding the level of IgM in serum indicated a significantly higher value of this parameter in patients with periodontal cyst compared to radicular and residual cyst before the intervention (p=0.0067) and 1 month after the intervention (p=0.0263). The levels of immunoglobulins in patients with odontogenic inflammatory cysts before surgical treatment were significantly elevated, depending on the type of the cyst. Their surgical removal generate a decrease in their level. These findings suggest that IgA, IgG and IgM may play an important role in the occurrence, development and persistence of cystic lesions. Keywords: Odontogenic inflammatory cysts, immunological analysis, humoral immune response, immunoglobulins IgA IgG and IgM.

Relationship between plasma cyclin-dependent kinase 5 levels and local immunoglobulin levels in patients with nasal polyps.

Nasal polyps are the most common benign nasal tumors that can lead to nasal obstruction and other annoying problems for the patient. Several hypotheses have been proposed as the basic mechanism of nasal polyps. In order to investigate one of the possible causes that can be a disorder in the regulation of systemic immune responses, the present study was designed to investigate the relationship between plasma cyclin-dependent kinase 5 (CDK5) levels and local immunoglobulin levels in patients with nasal polyps. A cross-section study was used to evaluate concentrations of local immunoglobulin levels (IgE, IgM, IgA, and IgG) on blood and polyp specimens from 60 patients with nasal polyps, and 60 control groups. Western Blot Analysis was done for CDK5 in plasma cells. IgA, IgG and IgE concentrations were significantly higher in polyp tissue specimens, but not in blood, of nasal polyp patients compared to the control group. Furthermore, plasma CDK5 levels were significantly higher in nasal polyp tissue compared with control. The difference in IgA, IgE and IgG expression between nasal polyp tissue and blood, supported by increased numbers of plasma cells, suggests a local production of these local immunoglobulins in nasal polyps in response to chronic antigens. Among local immunoglobulins, only there was a significant correlation between CDK5 with IgG (positive correlation) and IgE (negative correlation). The exact explanation for the relationship between plasma CDK5 and local immunoglobulins in nasal polyps needs further studies.

A third anti-SARS-CoV-2 mRNA dose does not overcome the pejorative impact of anti-CD20 therapy and/or low immunoglobulin levels in patients with lymphoma or chronic lymphocytic leukemia.

Not available.

Infectious agents, protein electrophoresis and immunoglobulin levels in patients with coronary artery ectasia

Abstract Background Even the mechanism of coronary artery ectasia (CAE) shares the common pathophysiologic steps and risk factors with atherosclerosis which led to assume that CAE is a variant of atherosclerosis, there are certain discrepancies or aspects incompatible of atherosclerosis. Purpose We hypothesized that pathophysiology of CAE might differ from that of atherosclerosis in terms of inflammatory parameters, infectious agents. Therefore, we assessed and compared the levels of IgG antibody against Chlamydia pneumonia, and Helicobacter Pylori, components of serum protein electrophoresis and plasma levels of total Ig G and Ig E. Materials and methods Seventy patients with coronary artery disease (CAD) and 30 patients with CAD coexisted with CAE comprised the study populations. Blood samples were allowed to clot at room temperature then centrifuged at 1500 rpm for 5 minutes then serum kept at deep freeze (−20°C) to be used for the measurement of IgG antibodies against C. pneumoniae and H. Pylori, total IgE, IgG levels and protein electrophoresis. Results There were not statistically significant differences between patients with and without CAE regarding the clinical and laboratory parameters except hemoglobin levels (Figure I). IgE, Alpha 2 macroglobulin, Beta-1 globulin levels were found to be higher in patients with CAE+CAD than those of CAD alone (Figure IIa). There was no statistically significant correlation between the Gensini score, and IgG antibody against H. Pylori (r=0.048, p=0.66) and C. Pneumoniae (r=−0.12, p=0.27) regarding the whole study population. Additionally, logistic regression analysis by including variables IgE, hemoglobin, Alpha 2 macroglobulin, beta-1 globulin, and gender, revealed that Ig E and alpha 2 macroglobulin were independently and positively associated with the presence of CAE (Figure IIb). Conclusion Independent association of serum IgE levels and alpha2 globulins with the presence of CAE underlines the divergent features of pathophysiology of CAE compared with atherosclerosis or CAD alone. Funding Acknowledgement Type of funding sources: None. Figure IFigure II

First case series of clozapine induced hypogammaglobulinaemia in England

Evidence is emerging that clozapine can adversely affect immunoglobulin levels. We present a case series of 17 clozapine-treated patients referred to clinical immunology centres in the north west of England with otherwise-unexplained hypogammaglobulinaemia. This adds to existing evidence and suggests that clozapine can cause clinically significant antibody deficiency that will sometimes require specialist intervention. We speculate that this putative drug toxicity could be mediated via interaction with PI3K (phosphatidylinositol-3-kinase) signalling pathways involved in the development and homeostasis of B cells. It may be advisable to monitor immunoglobulin levels in patients being treated with clozapine.

Association of Serum Immunoglobulin Levels with Solid Cancer: A Systematic Review and Meta-analysis.

The nature of humoral immunity in carcinogenesis remains poorly understood. In this systematic review and meta-analysis, we aimed to evaluate the association of serum immunoglobulin classes with solid cancer and test our hypothesis that the immune escape of tumors is accompanied by dysregulated systemic immunoglobulin class-switching. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched the Cochrane Library, Embase, and MEDLINE/PubMed databases for observational studies investigating the association between serum immunoglobulins (IgA, IgG, and IgM) and histologically confirmed diagnosis of solid cancer in adults. We selected case-control studies, including more than 20 cases, and those explicitly stating that no form of anticancer treatment was administered prior to immunoglobulin measurement. No eligible cohort studies were identified. The primary summary measure was the standardized mean difference (SMD) with 95% confidence intervals (CI) calculated using a random effects model. Pooling 11 eligible studies comparing serum IgA levels in 1,351 patients and 560 control subjects revealed a statistically significant SMD (1.50; 95% CI, 0.96-2.04). Nonsignificant SMDs were observed for the 14 selected studies investigating serum IgG [SMD, -0.02 (95% CI, -0.22 to 0.18)] and for the 10 studies reporting serum IgM [SMD, 0.11 (95% CI, -0.10 to 0.32)]. Substantial heterogeneity between studies was observed despite sensitivity analysis by immunoglobulin measurement method, control matching, type of cancer, stage of disease, and sequential study exclusion. Serum immunoglobulin levels in patients diagnosed with solid cancer might be skewed toward class-switching to IgA, possibly reflecting Th2-polarized immunity. Further combinatorial analyses of serum immunoglobulin isotypes alongside other immune parameters in databases and observational studies are warranted.

The Effect of Ocrelizumab Therapy on Immunoglobulin Levels in Patients with Multiple Sclerosis (P4.2-042)

The Effect of Ocrelizumab Therapy on Immunoglobulin Levels in Patients with Multiple Sclerosis (P4.2-042)

Aberrant B-cell Subsets and Immunoglobulin Levels in Patients with Moderate-to-severe Psoriasis.

Aberrant B-cell Subsets and Immunoglobulin Levels in Patients with Moderate-to-severe Psoriasis.

The effect of omalizumab treatment on IgE and other immunoglobulin levels in patients with chronic spontaneous urticaria and its association with treatment response.

IntroductionSuppression of free immunoglobulin E (IgE) levels and an increase in total IgE levels are observed during omalizumab treatment. However, whether omalizumab has any effect on other immunoglobulins is unknown.AimTo investigate the effect of omalizumab treatment on serum IgE and other immunoglobulins, and demonstrate any association with response to treatment in patients with chronic spontaneous urticaria (CSU).Material and methodsThe study included 41 patients diagnosed with CSU. Baseline and post-12-week-treatment total IgE, IgA, IgM, and IgG levels and blood eosinophil, neutrophil, lymphocyte and platelet levels were compared. Patients were grouped based on weekly urticaria activity score (UAS-7) responses and these parameters were compared.ResultsThere was a significant increase in baseline and post-12-week-treatment total IgE levels, while there was no significant difference in other immunoglobulin levels. A significant reduction was found in neutrophil counts after the treatment, whereas there was no significant difference in eosinophil, lymphocyte and platelet levels. There was no difference in these parameters between groups with complete response and without complete response.ConclusionsOmalizumab treatment can also be used in patients with immunoglobulin deficiency. Due to the observed reduction in neutrophil counts after the treatment, patients must be closely followed for whole blood parameters.

Serum immunoglobulin levels in patients with lymphoproliferative diseases in Erbil, Kurdistan region, Iraq

Background and objectives: Lymphoproliferative neoplasms are among the commonest human neoplasia. Immune dysregulation is frequently associated with many of these diseases, particularly those related to B-cell origin. This study aimed to find out the immunological status of newly diagnosed patients with lymphoproliferative disorders. Methods: This study was carried out in Erbil province during the period from November 2010 to April 2011. Fifty two newly diagnosed patients (34 males and 18 females) with lymphoproliferative disorders referred to Nnakaly Hospital for blood disease and 20 healthy control subjects had been included in this study. Determination of immunoglobulin subclasses by radial immunodiffusion in addition serum protein electrophoresis has been performed for each sample for the detection of monoclonal bands. Results: Serum IgM and IgA level were decreased in all groups of patients with different lymphoproliferative disorders compared to control group. Serum IgG level showed insignificant reduction in acute lymphocytic leukemia and chronic lymphocytic leukemia patients, but it was increased in non Hodgkin lymphoma, Hodgkin lymphoma and multiple myeloma patients. Paraproteinemia had been seen in all patients with multiple myeloma while only 10% of chronic lymphocytic leukemia and non Hodgkin lymphoma showed paraproteinemia. No M-band had been noticed in acute lymphocytic leukemia and Hodgkin lymphoma. Conclusion: There were some conflicting data regarding serum immunoglobulin levels in newly diagnosed patients with lymphoproliferative disorders in Erbil, Iraq.

Pragmatic Treatment of Patients With Systemic Lupus Erythematosus With Rituximab: Long‐Term Effects on Serum Immunoglobulins

ObjectiveB cell–depletion therapy based on rituximab is a therapeutic option for refractory disease in patients with systemic lupus erythematosus (SLE). The aim of this observational study was to document long‐term effects on B cell function by following serum immunoglobulin levels in patients with SLE treated with rituximab in routine clinical practice.MethodsWe included 57 consecutive patients with SLE treated with rituximab and concomitant/sequential immunosuppressants and measured serum total IgG, IgM, and IgA and IgG anti‐dsDNA antibodies, over a median of 48 months most recent followup. Flow cytometry was used prospectively to assess B cell phenotypes in 17 of 57 patients.ResultsTwelve patients (21%) had persistent IgM hypogammaglobulinemia (<0.4 gm/liter), and 4 of 57 (5%) had low IgG (<7 gm/liter) at the most recent followup (range 12–144 months). This was not associated with serious adverse events or high anti–double‐stranded DNA (anti‐dsDNA) antibodies (>1,000 IU/ml; normal <50 IU/ml). Factors predictive of low serum IgM included baseline serum IgM ≤0.8 gm/liter (receiver operator curve analysis) and subsequent therapy with mycophenolate mofetil (MMF; odds ratio 6.8, compared with other immunosuppressants). In patients maintaining normal IgM levels (9 of 17), the frequency of circulating IgD+CD27+ B cells was significantly higher (P = 0.05). At 12 months after rituximab, 7 of 30 SLE patients with baseline anti‐dsDNA ≤1,000 IU/ml had lost seropositivity.ConclusionLower baseline serum IgM levels and sequential therapy with MMF were predictive of IgM hypogammaglobulinemia after rituximab in SLE, but this was not associated with higher levels of anti‐dsDNA antibodies or an increased risk of infections. This provides useful directions for clinicians regarding rituximab and sequential immunosuppressive treatment for patients with SLE.

IgG2 as an independent risk factor for mortality in patients with community-acquired pneumonia

BackgroundMortality in patients with community-acquired pneumonia (CAP) remains high despite improvements in treatment. ObjectiveTo determine immunoglobulin levels in patients with CAP and impact on disease severity and mortality. MethodologyObservational study. Hospitalized patients with CAP were followed up for 30 days. Levels of immunoglobulin G (IgG) and subclasses, immunoglobulin A (IgA) and immunoglobulin M (IgM) were measured in serum within 24 hours of CAP diagnosis. ResultsThree hundred sixty-two patients with CAP were enrolled −172 ward-treated and 190 intensive care unit-treated. Intensive care unit–treated patients had significantly lower values of IgG1, IgG2, IgG3 subclasses, and IgA than ward-treated patients. Thirty-eight patients died before 30 days. Levels of IgG2 were significantly lower in non-survivors than survivors (P=.004) and IgG2 <301 mg/dL was associated with poorer survival according to both the bivariate (hazard ratio 4.47; P<.001) and multivariate (HR 3.48; P=.003) analyses. ConclusionsPatients with CAP with IgG2 levels <301 mg/dL had a poorer prognosis and a higher risk of death. Our study suggests the usefulness of IgG2 to predict CAP evolution and to provide support measures or additional treatment.