Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, UK.
Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.
Autoimmun Rev. 2019 May;18(5):535-541. doi: 10.1016/j.autrev.2019.03.010. Epub 2019 Mar 4.
Consensus guidelines are not available for the use of immunoglobulin replacement therapy (IGRT) in patients developing iatrogenic secondary antibody deficiency following B-cell targeted therapy (BCTT) in autoimmune rheumatic disease.
To evaluate the role of IGRT to manage hypogammaglobulinemia following BCTT in autoimmune rheumatic disease (AIRD).
Using an agreed search string we performed a systematic literature search on Medline with Pubmed as vendor. We limited the search to English language papers with abstracts published over the last 10 years. Abstracts were screened for original data regarding hypogammaglobulinemia following BCTT and the use of IGRT for hypogammaglobulinemia following BCTT. We also searched current recommendations from national/international organisations including British Society for Rheumatology, UK Department of Health, American College of Rheumatology, and American Academy of Asthma, Allergy and Immunology.
222 abstracts were identified. Eight papers had original relevant data that met our search criteria. These studies were largely retrospective cohort studies with small patient numbers receiving IGRT. The literature highlights the induction of a sustained antibody deficiency, risk factors for hypogammaglobulinemia after BCTT including low baseline serum IgG levels, how to monitor patients for the development of hypogammaglobulinemia and the limited evidence available on intervention thresholds for commencing IGRT.
The benefit of BCTT needs to be balanced against the risk of inducing a sustained secondary antibody deficiency. Consensus guidelines would be useful to enable appropriate assessment prior to and following BCTT in preventing and diagnosing hypogammaglobulinemia. Definitions for symptomatic hypogammaglobulinemia, intervention thresholds and treatment targets for IGRT, and its cost-effectiveness are required.
在自身免疫性风湿病患者中，B 细胞靶向治疗（BCTT）后发生医源性继发性抗体缺乏症时，尚无免疫球蛋白替代疗法（IGRT）使用的共识指南。
评估 IGRT 在管理自身免疫性风湿病（AIRD）BCTT 后低丙种球蛋白血症中的作用。
我们使用商定的搜索字符串在 Medline 上进行了系统文献检索，Pubmed 作为供应商。我们将搜索范围限制在过去 10 年内发表的具有摘要的英语论文。筛选摘要以获取关于 BCTT 后低丙种球蛋白血症和 IGRT 用于 BCTT 后低丙种球蛋白血症的原始数据。我们还搜索了来自英国风湿病学会、英国卫生部、美国风湿病学会和美国哮喘、过敏和免疫学学会等国家/国际组织的当前建议。
确定了 222 篇摘要。有 8 篇论文具有符合我们搜索标准的原始相关数据。这些研究主要是回顾性队列研究，接受 IGRT 的患者人数较少。文献强调了持续抗体缺乏的诱导、BCTT 后低丙种球蛋白血症的危险因素，包括基线血清 IgG 水平低、如何监测患者低丙种球蛋白血症的发生以及关于开始 IGRT 的干预阈值的有限证据。
BCTT 的益处需要与诱导持续继发性抗体缺乏的风险相平衡。共识指南将有助于在 BCTT 之前和之后进行适当的评估，以预防和诊断低丙种球蛋白血症。需要定义有症状的低丙种球蛋白血症、IGRT 的干预阈值和治疗目标以及其成本效益。
