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10.1002/art.40032

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suck abstract from ncbi


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pmid28029751
      Arthritis+Rheumatol 2017 ; 69 (5 ): 1045-1053
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  • Effect of Continuous B Cell Depletion With Rituximab on Pathogenic Autoantibodies and Total IgG Levels in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis #MMPMID28029751
  • Cortazar FB ; Pendergraft WF 3rd ; Wenger J ; Owens CT ; Laliberte K ; Niles JL
  • Arthritis Rheumatol 2017[May]; 69 (5 ): 1045-1053 PMID28029751 show ga
  • OBJECTIVE: To evaluate the effect of rituximab on pathogenic autoantibodies and total Ig levels, and to identify serious adverse events in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) treated with continuous B cell depletion. METHODS: We conducted a retrospective analysis of 239 patients with AAV treated with rituximab-induced continuous B cell depletion. Two treatment cohorts were analyzed: an induction group (n?=?52) and a maintenance group (n?=?237). Changes in ANCA titers and total Ig levels over time were evaluated using mixed-effects models. Risk factors for serious infections during maintenance treatment were evaluated using Poisson regression. RESULTS: During induction, IgG levels fell at a mean rate of 6% per month (95% confidence interval [95% CI] 4, 8%), while ANCA levels declined at a mean rate of 47% per month (95% CI 42, 52%) and 48% per month (95% CI 42, 54%) for patients with antimyeloperoxidase (anti-MPO) antibodies and those with anti-proteinase 3 (anti-PR3) antibodies, respectively. During maintenance treatment, with a median duration of 2.4 years (interquartile range 1.5, 4.0 years), IgG levels declined a mean of 0.6% per year (95% CI -0.2, 1.4%). New significant hypogammaglobulinemia (IgG level of <400 mg/dl) during maintenance treatment occurred in 4.6% of the patients, all of whom were in the lowest baseline IgG quartile. Serious infections during maintenance therapy occurred at a rate of 0.85 per 10 patient-years (95% CI 0.66, 1.1) and were independently associated with an IgG level of <400 mg/dl. CONCLUSION: B cell-targeted therapy causes a preferential decline in ANCA titers relative to total IgG levels. Despite prolonged maintenance therapy with rituximab, IgG levels remain essentially constant. Serious infections were rare.
  • |Aged [MESH]
  • |Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*drug therapy/immunology [MESH]
  • |Antirheumatic Agents/*therapeutic use [MESH]
  • |Autoantibodies/*immunology [MESH]
  • |Female [MESH]
  • |Humans [MESH]
  • |Immunoglobulin G/*immunology [MESH]
  • |Immunologic Deficiency Syndromes/chemically induced [MESH]
  • |Infections/etiology/immunology [MESH]
  • |Maintenance Chemotherapy [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Myeloblastin/*immunology [MESH]
  • |Peroxidase/*immunology [MESH]
  • |Remission Induction [MESH]
  • |Retrospective Studies [MESH]


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