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Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Arthritis+Rheumatol 2017 ; 69 (5): 1045-53 Nephropedia Template TP
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The effect of continuous B cell depletion with rituximab on pathogenic autoantibodies and total IgG levels in ANCA vasculitis #MMPMID28029751
Arthritis Rheumatol 2017[May]; 69 (5): 1045-53 PMID28029751show ga
Objective: To evaluate the effect of rituximab on pathogenic autoantibodies and total immunoglobulin levels, and to identify serious adverse events, in patients with ANCA vasculitis treated with continuous B cell depletion. Methods: We conducted a retrospective analysis of 239 patients with ANCA vasculitis treated with rituximab-induced continuous B cell depletion. Two treatment cohorts were analyzed: an induction group (n= 53) and a maintenance group (n=237). The change in ANCA titers and total immunoglobulin levels over time were evaluated using mixed-effects models. Risk factors for serious infections during maintenance were evaluated with Poisson regression. Results: During induction, IgG levels fell at a rate of 6% per month (95% CI, 4 to 8%), while ANCA levels declined at 47% per month (95% CI, 42 to 52%) and 48% per month (95% CI, 42 to 54%) for anti-MPO and anti-PR3 titers, respectively. During maintenance treatment, with a median duration of 2.4 (IQR, 1.5- 4.0) years, IgG levels declined at 0.6% per year (95% CI, -0.2 to 1.4%). New significant hypogammaglobulinemia (IgG < 400 mg/dL) during maintenance occurred in 4.6% of patients, all of whom were in the lowest baseline IgG quartile. Serious infections during maintenance occurred at a rate of 0.85 [95% CI, 0.66 to 1.1] per 10 patient years and were independently associated with an IgG level < 400mg/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.