Low immunoglobulin levels increase the risk of severe hypogammaglobulinemia in granulomatosis with polyangiitis patients receiving rituximab

BMC Musculoskeletal Disorders

Research Article

Emilio Besada¹ 

[1] Bone and Joint Research Group, Institute of Clinical Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway;

关键词: ANCA-associated vasculitis;    Rituximab;    Induction;    Maintenance;    Immunoglobulin;    Hypogammaglobulinemia;    Discontinuation;    Adverse event;    Principal component analysis;    Correspondence analysis;   

DOI  :  10.1186/s12891-015-0860-3

 received in 2015-06-09, accepted in 2015-12-23,  发布年份 2016

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© besada. 2016