Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study

Manuel Alfredo Podestà; Federica Mescia; Anna Ricchiuto; Rona Smith; Martina Tedesco; Matthias Arnaldo Cassia; Julia Holle; Renato Alberto Sinico; Annette Bruchfeld; Iva Gunnarsson; Sophie Ohlsson; Bo Baslund; Zdenka Hruskova; Vladimir Tesar; Gianmarco Sabiu; Maurizio Gallieni; Maria C Cid; Augusto Vaglio; Lorraine Harper; Mario Cozzolino; Francesco Scolari; David Jayne; Federico Alberici

doi:10.1093/rheumatology/keac716

Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study

Manuel Alfredo Podestà, Federica Mescia, Anna Ricchiuto, Rona Smith, Martina Tedesco, Matthias Arnaldo Cassia, Julia Holle, Renato Alberto Sinico, Annette Bruchfeld, Iva Gunnarsson, Sophie Ohlsson, Bo Baslund, Zdenka Hruskova, Vladimir Tesar, Gianmarco Sabiu, Maurizio Gallieni, Maria C Cid, Augusto Vaglio, Lorraine Harper, Mario CozzolinoFrancesco Scolari, David Jayne, Federico Alberici

Autoimmunity and kidney diseases

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: Rituximab has become the cornerstone of induction treatment in ANCA-associated vasculitis (AAV). B cell depletion may increase the risk of hypogammaglobulinemia, potentially leading to severe infections. This study aims to assess factors associated with hypogammaglobulinemia in AAV patients treated with rituximab.

METHODS: This retrospective cohort study included AAV patients treated with rituximab induction in 14 European centers. Severe adverse events (SAEs) were defined as episodes requiring hospitalization or intravenous antibiotics, malignancies, or death. Linear and logistic regression were used to identify predictors of IgG levels and of the risk of hypogammaglobulinemia, defined as IgG ≤7 g/l at 6 months.

RESULTS: The study included 227 patients. IgG levels at 6 months were lower than baseline (p< 0.001). Patients requiring intravenous antibiotics during the first 6 months had lower IgG levels at 6 months (p= 0.004). Age (β [95%CI]: -0.23 [-0.38;-0.08] per 10 years, p= 0.003), oral glucocorticoid dose at induction (β [95%CI]:-0.37[-0.51;-0.24] per sqrt-transformed mg prednisone, p< 0.001) and concomitant use of intravenous glucocorticoid pulses (β [95%CI]:-0.88[-1.73;-0.02], p= 0.044) were associated with IgG levels at 6 months. Hypogammaglobulinemia was identified in 97 (42.7%) patients. In multivariable logistic regression, factors associated with the risk of hypogammaglobulinemia were age (OR [95%CI]: 1.46 [1.15; 1.86] per 10 years, p= 0.002) and oral glucocorticoid dose at induction (OR [95%CI]: 1.52[1.23; 1.89] per 10 mg prednisone, p< 0.001).

CONCLUSIONS: In AAV patients treated with rituximab, hypogammaglobulinemia at 6 months after induction is common, and lower IgG levels are associated with serious infections. The risk of hypogammaglobulinemia in these patients increases with age and higher glucocorticoid doses.

Original language	English
Article number	keac716
Pages (from-to)	2850-2854
Journal	Rheumatology (Oxford, England)
Volume	62
Issue number	8
DOIs	https://doi.org/10.1093/rheumatology/keac716
Publication status	Published - 2023

Subject classification (UKÄ)

Rheumatology and Autoimmunity

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10.1093/rheumatology/keac716

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Podestà, M. A., Mescia, F., Ricchiuto, A., Smith, R., Tedesco, M., Cassia, M. A., Holle, J., Sinico, R. A., Bruchfeld, A., Gunnarsson, I., Ohlsson, S., Baslund, B., Hruskova, Z., Tesar, V., Sabiu, G., Gallieni, M., Cid, M. C., Vaglio, A., Harper, L., ... Alberici, F. (2023). Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study. Rheumatology (Oxford, England), 62(8), 2850-2854. Article keac716. https://doi.org/10.1093/rheumatology/keac716

@article{f599280c135342318ad79089efa7ae02,

title = "Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study",

abstract = "OBJECTIVES: Rituximab has become the cornerstone of induction treatment in ANCA-associated vasculitis (AAV). B cell depletion may increase the risk of hypogammaglobulinemia, potentially leading to severe infections. This study aims to assess factors associated with hypogammaglobulinemia in AAV patients treated with rituximab.METHODS: This retrospective cohort study included AAV patients treated with rituximab induction in 14 European centers. Severe adverse events (SAEs) were defined as episodes requiring hospitalization or intravenous antibiotics, malignancies, or death. Linear and logistic regression were used to identify predictors of IgG levels and of the risk of hypogammaglobulinemia, defined as IgG ≤7 g/l at 6 months.RESULTS: The study included 227 patients. IgG levels at 6 months were lower than baseline (p< 0.001). Patients requiring intravenous antibiotics during the first 6 months had lower IgG levels at 6 months (p= 0.004). Age (β [95%CI]: -0.23 [-0.38;-0.08] per 10 years, p= 0.003), oral glucocorticoid dose at induction (β [95%CI]:-0.37[-0.51;-0.24] per sqrt-transformed mg prednisone, p< 0.001) and concomitant use of intravenous glucocorticoid pulses (β [95%CI]:-0.88[-1.73;-0.02], p= 0.044) were associated with IgG levels at 6 months. Hypogammaglobulinemia was identified in 97 (42.7%) patients. In multivariable logistic regression, factors associated with the risk of hypogammaglobulinemia were age (OR [95%CI]: 1.46 [1.15; 1.86] per 10 years, p= 0.002) and oral glucocorticoid dose at induction (OR [95%CI]: 1.52[1.23; 1.89] per 10 mg prednisone, p< 0.001).CONCLUSIONS: In AAV patients treated with rituximab, hypogammaglobulinemia at 6 months after induction is common, and lower IgG levels are associated with serious infections. The risk of hypogammaglobulinemia in these patients increases with age and higher glucocorticoid doses.",

author = "Podest{\`a}, {Manuel Alfredo} and Federica Mescia and Anna Ricchiuto and Rona Smith and Martina Tedesco and Cassia, {Matthias Arnaldo} and Julia Holle and Sinico, {Renato Alberto} and Annette Bruchfeld and Iva Gunnarsson and Sophie Ohlsson and Bo Baslund and Zdenka Hruskova and Vladimir Tesar and Gianmarco Sabiu and Maurizio Gallieni and Cid, {Maria C} and Augusto Vaglio and Lorraine Harper and Mario Cozzolino and Francesco Scolari and David Jayne and Federico Alberici",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].",

year = "2023",

doi = "10.1093/rheumatology/keac716",

language = "English",

volume = "62",

pages = "2850--2854",

journal = "Rheumatology (Oxford, England)",

issn = "1462-0332",

publisher = "Oxford University Press",

number = "8",

}

Podestà, MA, Mescia, F, Ricchiuto, A, Smith, R, Tedesco, M, Cassia, MA, Holle, J, Sinico, RA, Bruchfeld, A, Gunnarsson, I, Ohlsson, S, Baslund, B, Hruskova, Z, Tesar, V, Sabiu, G, Gallieni, M, Cid, MC, Vaglio, A, Harper, L, Cozzolino, M, Scolari, F, Jayne, D & Alberici, F 2023, 'Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study', Rheumatology (Oxford, England), vol. 62, no. 8, keac716, pp. 2850-2854. https://doi.org/10.1093/rheumatology/keac716

TY - JOUR

T1 - Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction

T2 - a multicentre study

AU - Podestà, Manuel Alfredo

AU - Mescia, Federica

AU - Ricchiuto, Anna

AU - Smith, Rona

AU - Tedesco, Martina

AU - Cassia, Matthias Arnaldo

AU - Holle, Julia

AU - Sinico, Renato Alberto

AU - Bruchfeld, Annette

AU - Gunnarsson, Iva

AU - Ohlsson, Sophie

AU - Baslund, Bo

AU - Hruskova, Zdenka

AU - Tesar, Vladimir

AU - Sabiu, Gianmarco

AU - Gallieni, Maurizio

AU - Cid, Maria C

AU - Vaglio, Augusto

AU - Harper, Lorraine

AU - Cozzolino, Mario

AU - Scolari, Francesco

AU - Jayne, David

AU - Alberici, Federico

PY - 2023

Y1 - 2023

N2 - OBJECTIVES: Rituximab has become the cornerstone of induction treatment in ANCA-associated vasculitis (AAV). B cell depletion may increase the risk of hypogammaglobulinemia, potentially leading to severe infections. This study aims to assess factors associated with hypogammaglobulinemia in AAV patients treated with rituximab.METHODS: This retrospective cohort study included AAV patients treated with rituximab induction in 14 European centers. Severe adverse events (SAEs) were defined as episodes requiring hospitalization or intravenous antibiotics, malignancies, or death. Linear and logistic regression were used to identify predictors of IgG levels and of the risk of hypogammaglobulinemia, defined as IgG ≤7 g/l at 6 months.RESULTS: The study included 227 patients. IgG levels at 6 months were lower than baseline (p< 0.001). Patients requiring intravenous antibiotics during the first 6 months had lower IgG levels at 6 months (p= 0.004). Age (β [95%CI]: -0.23 [-0.38;-0.08] per 10 years, p= 0.003), oral glucocorticoid dose at induction (β [95%CI]:-0.37[-0.51;-0.24] per sqrt-transformed mg prednisone, p< 0.001) and concomitant use of intravenous glucocorticoid pulses (β [95%CI]:-0.88[-1.73;-0.02], p= 0.044) were associated with IgG levels at 6 months. Hypogammaglobulinemia was identified in 97 (42.7%) patients. In multivariable logistic regression, factors associated with the risk of hypogammaglobulinemia were age (OR [95%CI]: 1.46 [1.15; 1.86] per 10 years, p= 0.002) and oral glucocorticoid dose at induction (OR [95%CI]: 1.52[1.23; 1.89] per 10 mg prednisone, p< 0.001).CONCLUSIONS: In AAV patients treated with rituximab, hypogammaglobulinemia at 6 months after induction is common, and lower IgG levels are associated with serious infections. The risk of hypogammaglobulinemia in these patients increases with age and higher glucocorticoid doses.

AB - OBJECTIVES: Rituximab has become the cornerstone of induction treatment in ANCA-associated vasculitis (AAV). B cell depletion may increase the risk of hypogammaglobulinemia, potentially leading to severe infections. This study aims to assess factors associated with hypogammaglobulinemia in AAV patients treated with rituximab.METHODS: This retrospective cohort study included AAV patients treated with rituximab induction in 14 European centers. Severe adverse events (SAEs) were defined as episodes requiring hospitalization or intravenous antibiotics, malignancies, or death. Linear and logistic regression were used to identify predictors of IgG levels and of the risk of hypogammaglobulinemia, defined as IgG ≤7 g/l at 6 months.RESULTS: The study included 227 patients. IgG levels at 6 months were lower than baseline (p< 0.001). Patients requiring intravenous antibiotics during the first 6 months had lower IgG levels at 6 months (p= 0.004). Age (β [95%CI]: -0.23 [-0.38;-0.08] per 10 years, p= 0.003), oral glucocorticoid dose at induction (β [95%CI]:-0.37[-0.51;-0.24] per sqrt-transformed mg prednisone, p< 0.001) and concomitant use of intravenous glucocorticoid pulses (β [95%CI]:-0.88[-1.73;-0.02], p= 0.044) were associated with IgG levels at 6 months. Hypogammaglobulinemia was identified in 97 (42.7%) patients. In multivariable logistic regression, factors associated with the risk of hypogammaglobulinemia were age (OR [95%CI]: 1.46 [1.15; 1.86] per 10 years, p= 0.002) and oral glucocorticoid dose at induction (OR [95%CI]: 1.52[1.23; 1.89] per 10 mg prednisone, p< 0.001).CONCLUSIONS: In AAV patients treated with rituximab, hypogammaglobulinemia at 6 months after induction is common, and lower IgG levels are associated with serious infections. The risk of hypogammaglobulinemia in these patients increases with age and higher glucocorticoid doses.

U2 - 10.1093/rheumatology/keac716

DO - 10.1093/rheumatology/keac716

M3 - Article

C2 - 36562566

SN - 1462-0332

VL - 62

SP - 2850

EP - 2854

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

IS - 8

M1 - keac716

ER -

Predictors of hypogammaglobulinemia in ANCA-associated vasculitis after a rituximab-based induction: a multicentre study

Abstract

Subject classification (UKÄ)

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