Giraud M, Cathébras P, Roblin X, Thibaudin D, Lamure S, Mariat C, Paul S, Killian M
Service de médecine Interne, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France.
Service de Gastro-entérologie, hôpital Nord, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 02, France.
Rev Med Interne. 2021 Jun;42(6):384-391. doi: 10.1016/j.revmed.2021.02.006. Epub 2021 Mar 5.
Immune monitoring of monoclonal antibodies is a helpful tool in optimizing the management of patients treated with TNF blockers, especially in gastroenterology. In contrast, studies evaluating the interest of such monitoring are lacking for other monoclonal antibodies used in autoimmune diseases, including rituximab despite its widespread use in the field for almost 15 years. Hence, we conducted a study whose goal was to describe the clinical and biological characteristics of all patients who had a rituximab immune monitoring.
All the clinical, biological and therapeutic data attached to the demands (from 2015 onwards) we received for immune monitoring of rituximab (measurements of rituximab serum levels and anti-rituximab antibodies using the drug-sensitive assay LISA-TRACKER Duo Rituximab®), were retrospectively reviewed. Suspected cases of hypersensitivity and secondary non-response were included.
Several medical specialities (nephrology, haematology, neurology, rheumatology, internal medicine) were represented among the 18 records included in the study (out of 23 demands), 10 being suspected cases of hypersensitivity and 8 secondary non-responders. All 6 patients whose symptoms were consistent with the classical presentation of serum sickness, as well as half of the secondary non-responders, were positive for antirituximab antibodies.
This detailed real world case study illustrates the potential benefits of rituximab immune monitoring (especially anti-rituximab antibodies) in autoimmune diseases, suggesting it could be helpful in suspected cases of serum sickness, as well as secondary non-response (B-cell non-depletion being an early red flag). Larger and disease-specific studies are warranted to support these findings.
单克隆抗体的免疫监测是优化使用肿瘤坏死因子阻滞剂治疗患者管理的有用工具，尤其是在胃肠病学领域。相比之下，对于自身免疫性疾病中使用的其他单克隆抗体，包括利妥昔单抗（尽管其在该领域广泛使用近15年），评估此类监测作用的研究却很缺乏。因此，我们开展了一项研究，其目的是描述所有接受利妥昔单抗免疫监测患者的临床和生物学特征。
我们回顾性分析了收到的（自2015年起）所有与利妥昔单抗免疫监测需求相关的临床、生物学和治疗数据（使用药物敏感检测法LISA-TRACKER Duo Rituximab®测量利妥昔单抗血清水平和抗利妥昔单抗抗体）。纳入疑似过敏和继发性无反应病例。
该研究纳入的18份记录（共23项需求）涉及多个医学专科（肾脏病学、血液学、神经病学、风湿病学、内科），其中10例为疑似过敏病例，8例为继发性无反应者。所有6例症状与血清病典型表现相符的患者以及一半的继发性无反应者抗利妥昔单抗抗体呈阳性。
这项详细的真实世界案例研究说明了利妥昔单抗免疫监测（尤其是抗利妥昔单抗抗体）在自身免疫性疾病中的潜在益处，表明其在疑似血清病病例以及继发性无反应（B细胞未耗竭是早期警示信号）中可能有用。需要开展更大规模的针对特定疾病的研究来支持这些发现。
