Akademik Veri Yönetim Sistemi
Journal of Turkish Society For Rheumatology, cilt.15, sa.3, ss.154-161, 2023 (Scopus)
Objective: To assess the frequency and related factors of hypogammaglobulinemia (HGG) and severe infections in patients who received rituximab (RTX) for rheumatic diseases during routine follow-up. Methods: Patients who were followed in Marmara University Rheumatology Clinic and received RTX are evaluated retrospectively. The immunoglobulin (Ig) G, IgM, IgA levels and clinical manifestations were obtained from patient files. The HGG frequency and related factors were assessed. Severe infections were also analysed. Results: A total of 144 patients were included (F/M: 105/39, mean age 52.8±13.8). In the majority of the patients (67%) the diagnosis was rheumatoid arthritis (RA). At least one subgroup of HGG was observed in 30% (43/144) of the patients. During follow-up 17 (11.8%) patients had low IgG, 37 (26%) low IgM, and 7 (4%) had low IgA levels. HGG rate was similar between RA, connective tissue diseases and anti-neutrophil cytoplasmic antibody associated vasculitis patients (25%, 30%, 47%, respectively, p=0.13). HGG was more frequent in men (p=0.028), in patients with higher accumulated RTX dose (p=0.006) and with hypertension (p=0.033). Concomitant use of disease-modifying anti-rheumatic drugs, glucocorticoid use and prior cyclophosphamide was not associated with higher HGG. Methotrexate use with RTX was a protective factor for HGG (HGG rate methotrexate + vs-: 12% vs 33%, p=0.032). Two patients with HGG (5%) received intravenous immunoglobulin replacement. Twenty-seven patients (18%) had severe infections. Lower IgG levels [IgG levels odds rato (OR) (95% confidence interval [CI]) 0.82 (0.70-0.96), p=0.018] and chronic lung disease (CLD) [CLD present OR (95% CI) 3.7 (1.2-10.8), p=0.017] were associated with severe infections in multivariate analysis. A total of 38 patients died during follow-up. Mortality was more frequent in patients with HGG [mortality rate HGG+ vs HGG-: 40% (17/43) vs 21% (20/101), p=0.02]. Conclusion: While male gender, increased number of RTX courses and hypertension were found to be risk factors for HGG, CLD and lower IgG levels were associated with severe infections. Therefore, measuring Ig levels and assessing risk factors for HGG and severe infections during RTX treatment may provide information to prevent both conditions.