Segelmark Leo, Flores-Suárez Luis, Mohammad Aladdin
Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
Rheumatology (Oxford). 2021 Dec 24;61(1):205-212. doi: 10.1093/rheumatology/keab293.
Rituximab (RTX) is an anti-CD20 antibody that selectively depletes B cells and has emerged as a therapy for ANCA-associated vasculitis (AAV) during the past decade. This study sought to quantify and determine potential risk factors for severe infections in AAV patients treated with RTX at rheumatology clinics in Mexico City, Mexico and Lund, Sweden.
The study consisted of a retrospective case-record review (2005-15) with standardized data collection related to the occurrence of severe infection in 46 patients with AAV in Mexico City (n = 20) and Lund (n = 26) treated with RTX during their disease course. Median duration of follow-up from first RTX dose to death or end of study was 26 months.
Eleven (24%) patients suffered a total of 18 severe infections (infection rate of 11.5/100 patient-years). Thirteen of the 18 infections (72%) occurred within the first year of treatment. Risk factors for severe infection were older age at RTX initiation and absence of ENT involvement at diagnosis. In multivariate analyses, age at RTX infusion was the only independent factor predicting severe infection. Four patients (9%) died during follow-up, all as a result of infection.
Severe infections are common following RTX treatment, and mortality due to infection is a major concern. Most severe infections occur within the first year of RTX treatment. The negative correlation of ENT involvement with severe infection might reflect granulomatosis with polyangiitis phenotype heterogeneity. Older age at time of RTX treatment independently predicts severe infections.
利妥昔单抗（RTX）是一种抗CD20抗体，可选择性清除B细胞，在过去十年中已成为抗中性粒细胞胞浆抗体相关性血管炎（AAV）的一种治疗方法。本研究旨在量化并确定在墨西哥城、墨西哥以及瑞典隆德的风湿病诊所接受RTX治疗的AAV患者发生严重感染的潜在风险因素。
该研究包括一项回顾性病例记录审查（2005 - 2015年），对46例在疾病过程中接受RTX治疗的墨西哥城（n = 20）和隆德（n = 26）的AAV患者发生严重感染的情况进行标准化数据收集。从首次使用RTX剂量到死亡或研究结束的中位随访时间为26个月。
11例（24%）患者共发生18次严重感染（感染率为11.5/100患者 - 年）。18次感染中的13次（72%）发生在治疗的第一年。严重感染的风险因素是开始使用RTX时年龄较大以及诊断时无耳鼻喉受累。在多变量分析中，RTX输注时的年龄是预测严重感染的唯一独立因素。4例（9%）患者在随访期间死亡，均因感染所致。
RTX治疗后严重感染很常见，且感染导致的死亡率是一个主要问题。大多数严重感染发生在RTX治疗的第一年。耳鼻喉受累与严重感染的负相关可能反映了肉芽肿性多血管炎的表型异质性。RTX治疗时年龄较大独立预测严重感染。
