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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 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
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.