Elgenidy Anas, Abdelhalim Nagham Nader, Al-Kurdi Mohammed Al-Mahdi, Mohamed Lobna A, Ghoneim Mohamed M, Fathy Ahmed Wagdy, Hassaan Hazem Khaled, Anan Ahmed, Alomari Omar
Faculty of Medicine, Cairo University, Giza, Egypt.
Karl-Jaspers-Klinik, Bad Zwischenahn, Germany.
Front Neurol. 2024 Apr 18;15:1380654. doi: 10.3389/fneur.2024.1380654. eCollection 2024.
Recent years have seen the emergence of disease-modifying therapies in multiple sclerosis (MS), such as anti-cluster of differentiation 20 (anti-CD20) monoclonal antibodies, aiming to modulate the immune response and effectively manage MS. However, the relationship between anti-CD20 treatments and immunoglobulin G (IgG) levels, particularly the development of hypogammaglobulinemia and subsequent infection risks, remains a subject of scientific interest and variability. We aimed to investigate the intricate connection between anti-CD20 MS treatments, changes in IgG levels, and the associated risk of hypogammaglobulinemia and subsequent infections.
PubMed, Scopus, Embase, Cochrane, and Web of Science databases have been searched for relevant studies. The "R" software utilized to analyze the occurrence of hypogammaglobulinemia, infections and mean differences in IgG levels pre- and post-treatment. The subgrouping analyses were done based on drug type and treatment duration. The assessment of heterogeneity utilized the and chi-squared tests, applying the random effect model.
Thirty-nine articles fulfilled our inclusion criteria and were included in our review which included a total of 20,501 MS patients. The overall prevalence rate of hypogammaglobulinemia was found to be 11% (95% CI: 0.08 to 0.15). Subgroup analysis based on drug type revealed varying prevalence rates, with rituximab showing the highest at 18%. Subgroup analysis based on drug usage duration revealed that the highest proportion of hypogammaglobulinemia occurred in individuals taking the drugs for 1 year or less (19%). The prevalence of infections in MS patients with a focus on different infection types stratified by the MS drug used revealed that pulmonary infections were the most prevalent (9%) followed by urinary tract infections (6%), gastrointestinal infections (2%), and skin and mucous membrane infections (2%). Additionally, a significant decrease in mean IgG levels after treatment compared to before treatment, with a mean difference of 0.57 (95% CI: 0.22 to 0.93).
This study provides a comprehensive analysis of the impact of anti-CD20 drugs on serum IgG levels in MS patients, exploring the prevalence of hypogammaglobulinemia, based on different drug types, treatment durations, and infection patterns. The identified rates and patterns offer a foundation for clinicians to consider in their risk-benefit.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=518239, CRD42024518239.
近年来，多发性硬化症（MS）出现了疾病修正疗法，如抗分化簇20（anti-CD20）单克隆抗体，旨在调节免疫反应并有效管理MS。然而，抗CD20治疗与免疫球蛋白G（IgG）水平之间的关系，特别是低丙种球蛋白血症的发生及随后的感染风险，仍然是一个科学关注且存在差异的主题。我们旨在研究抗CD20治疗MS、IgG水平变化以及低丙种球蛋白血症及随后感染相关风险之间的复杂联系。
检索了PubMed、Scopus、Embase、Cochrane和Web of Science数据库中的相关研究。使用“R”软件分析低丙种球蛋白血症、感染的发生率以及治疗前后IgG水平的平均差异。基于药物类型和治疗持续时间进行亚组分析。使用I²和卡方检验评估异质性，应用随机效应模型。
39篇文章符合我们的纳入标准并被纳入综述，共纳入20,501例MS患者。发现低丙种球蛋白血症的总体患病率为11%（95%CI：0.08至0.15）。基于药物类型的亚组分析显示患病率各不相同，利妥昔单抗的患病率最高，为18%。基于用药持续时间的亚组分析显示，低丙种球蛋白血症比例最高的是用药1年及以内的个体（19%）。按所用MS药物分层关注不同感染类型时，MS患者感染的患病率显示肺部感染最为常见（9%），其次是尿路感染（6%）、胃肠道感染（2%）以及皮肤和黏膜感染（2%）。此外与治疗前相比，治疗后平均IgG水平显著降低，平均差异为0.57（95%CI：0.22至0.93）。
本研究全面分析了抗CD20药物对MS患者血清IgG水平的影响，基于不同药物类型、治疗持续时间和感染模式探讨了低丙种球蛋白血症的患病率。所确定的发生率和模式为临床医生在权衡风险效益时提供了参考依据。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=518239，CRD42024518239 。
