Rituximab-induced Hypogammaglobulinemia in Patients with Neuromyelitis Optica Spectrum Disorders

Overview

Journal Neurol Neuroimmunol Neuroinflamm

Specialty Neurology

Date 2018 Sep 28

PMID 30258855

Citations 45

Authors

Andrea Marcinno

Fabiana Marnetto

Paola Valentino

Serena Martire

Alessia Balbo

Aurora Drago

Maria Leto

Marco Capobianco

GianCarlo Panzica

Antonio Bertolotto

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the long-term effects of rituximab (RTX) on total and specific immunoglobulins (Igs) in patients with neuromyelitis optica spectrum disorders (NMOSDs).

Methods: Total IgG, IgA, and IgM levels were evaluated in 15 patients with NMOSDs treated with RTX (median follow-up 70 months). Anti-aquaporin 4 (AQP4)-IgG titration was performed on samples from 9 positive patients. Anti-tetanus (TET), anti-varicella-zoster virus (VZV), and anti-Epstein-Barr virus nuclear antigen (EBNA) IgGs were also tested in patients with NMOSDs and in 6 healthy controls (HCs).

Results: RTX reduced total IgG by 0.42 g/L per year, IgA by 0.08 g/L per year, and IgM by 0.07 g/L per year. Hypogammaglobulinemia (hypo-IgG) (IgG < 7 g/L) developed in 11/15 patients. Severe hypo-IgG (IgG < 4 g/L) was found in 3/15 patients, of whom 2 patients developed serious infectious complications. In group analysis, anti-AQP4 IgG titers were reduced by RTX over time, and a significant correlation between anti-AQP4 IgG titers and total IgG levels was found. The effects of RTX were observed on pathogen-specific IgGs as well. In particular, the levels of anti-TET IgG in patients were significantly lower than those in HCs. The half-life of anti-TET IgG was reduced by about 50% in patients compared with the general population.

Conclusions: Long-term RTX treatment is associated with the risk of hypo-Ig and reduction of anti-TET protection in patients with NMOSDs. Results obtained in this study suggest the importance of monitoring total and specific Ig levels before and during treatment with anti-CD20 drugs to prevent hypo-Ig-related complications and to optimize clinical management.

Citing Articles

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Hypogammaglobulinaemia during rituximab treatment in multiple sclerosis: A Swedish cohort study.

Hallberg S, Evertsson B, Lillvall E, Boremalm M, de Flon P, Wang Y Eur J Neurol. 2024; 31(8):e16331.

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Preziosa P, Amato M, Battistini L, Capobianco M, Centonze D, Cocco E J Neurol. 2024; 271(7):3879-3896.

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