Rheumatology Department, 417 Army Share Fund Hospital (NIMTS).
Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens.
Rheumatology (Oxford). 2021 May 14;60(5):2375-2382. doi: 10.1093/rheumatology/keaa617.
Rituximab (RTX) use in the treatment of RA can be complicated by decrease in IgG, IgM or IgA levels (hypogammaglobulinemia-HGG). The aim of this study was to define the frequency of HGG in RA patients treated with RTX and to identify associations between its occurrence and patients' characteristics, disease outcomes and serious infections rate.
RA patients treated with RTX in two rheumatology centers from January 2007 to January 2020 were retrospectively examined. Demographical, clinical and laboratory parameters were recorded at baseline and at last visit.
Eighty-three patients (84.3% females) with a mean age of 63.2 years were enrolled. They had baseline DAS28(CRP) of 5.2 (1.1) and received a median (range) of 8 (2-20) RTX cycles. A total of 43.4%, 24.1% and 31.3% developed 'any HGG', 'low IgG' and 'low IgM', respectively. Lower baseline IgG and IgM levels were predictors of 'low IgG' and 'low IgM' occurrence, respectively. Patients who developed 'low IgM' exhibited lower DAS28(CRP) and increased rates of remission and low disease activity compared with those with normal IgM levels. Patients who maintained normal IgG were receiving methotrexate more frequently. No differences were observed in serious infections rate among subgroups.
HGG occurred in 43% of RTX-treated patients. Patients who developed low IgG or low IgM had lower baseline levels than those who did not. Concomitant DMARD and corticosteroid therapy was not associated with HGG. Low IgM, but not low IgG, development was associated with better disease outcomes. HGG was not associated with an increased incidence of serious infections.
利妥昔单抗（RTX）治疗类风湿关节炎（RA）可导致 IgG、IgM 或 IgA 水平下降（低丙种球蛋白血症-HGG）。本研究旨在确定接受 RTX 治疗的 RA 患者中 HGG 的频率，并确定其发生与患者特征、疾病结局和严重感染率之间的关系。
回顾性检查了 2007 年 1 月至 2020 年 1 月在两个风湿病中心接受 RTX 治疗的 RA 患者。记录基线和最后一次就诊时的人口统计学、临床和实验室参数。
共纳入 83 例（84.3%为女性）女性，平均年龄 63.2±11.2 岁。他们的基线 DAS28（CRP）为 5.2±1.1，中位数（范围）接受 8（2-20）个 RTX 周期。分别有 43.4%、24.1%和 31.3%的患者发生“任何 HGG”、“低 IgG”和“低 IgM”。较低的基线 IgG 和 IgM 水平分别是发生“低 IgG”和“低 IgM”的预测因素。与 IgM 水平正常的患者相比，发生“低 IgM”的患者 DAS28（CRP）更低，缓解率和低疾病活动度更高。维持正常 IgG 的患者更常接受甲氨蝶呤治疗。各组间严重感染发生率无差异。
接受 RTX 治疗的患者中，有 43%发生 HGG。发生低 IgG 或低 IgM 的患者基线水平低于未发生的患者。同时使用 DMARD 和皮质类固醇治疗与 HGG 无关。低 IgM 的发生，而不是低 IgG 的发生，与更好的疾病结局相关。HGG 与严重感染发生率增加无关。
