Selective Immunoglobulin A Deficiency that Developed in the Long-Term Period after Rituximab Therapy
https://doi.org/10.31550/1727-2378-2022-21-6-63-66
Abstract
Objective of the Paper: To demonstrate the possibility of developing late-onset hypoimmunoglobulinemia after a course of immunosuppressive therapy.
Key points. A clinical observation is presented when a selective immunoglobulin A deficiency gradually developed in a patient with Sjögren's disease and MALT-lymphoma, who received rituximab for several years. It was associated with increased frequency of acute respiratory infections. The molecular mechanisms of secondary antibody deficiencies followed by immunisupressive therapy are virtually unknown and are likely to be heterogenous. It is necessary to carry out a differential diagnosis with primary immunodeficiencies.
Conclusion. This clinical observation confirms that when choosing rituximab or other anti-B-cell drugs as basic therapy, one should be aware of the possible development of hypoimmunoglobulinemia both during treatment and in the long-term period. Before starting treatment with rituximab, one must determine the initial levels of serum immunoglobulins to assess the risk of infectious complications and identify primary immunodeficiencies and monitor them even after discontinuation of the drug, particularly in patients with infections.
About the Author
O. V. Moskalets
Moscow Regional Research Clinical Institute named after M.F. Vladimirskiy
Russian Federation
Russian Federation
61/2 Schepkina Str., Moscow 115054
References
1. Nasonov E.L., Lila A.M. Rituximab and other anti-B-cell agents in immunemediated inflammatory rheumatic diseases. Clinical Pharmacology and Therapy. 2019; 28(1): 7–17 (in Russian). DOI: 10.32756/0869-5490-2019-1-7-17
2. Maloney D.G. Mechanisms of action of rituximab. Anticancer Drugs. 2001; 12(suppl.2): S1–4.
3. Hofmann K., Clauder A.-K., Manz R.A. Targeting B cells and plasma cells in autoimmune diseases. Front. Immunol. 2018; 9: 835. DOI: 10.3389/fimmu.2018.00835
4. Sacco K.A., Abraham R.S. Consequences of B-cell-depleting therapy: hypogammaglobulinemia and impaired B-cell reconstitution. Immunotherapy. 2018; 10(8): 713–28. DOI: 10.2217/imt-2017-0178
5. Moskalets O.V. Late-onset hypogammaglobulinemia after rituximab therapy. Kazan Medical Journal. 2019; 100(2): 288–94 (in Russian). DOI: 10.17816/KMJ2019-288
6. Roberts D.M., Jones R.B., Smith R.M., Alberci F. et al. Rituximabassociated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J. Autoimmun. 2015; 57: 60–5. DOI: 10.1016/j.jaut.2014.11.009
7. Barmettler S., Ong M.-S., Farmer J.R., Choi H. et al. Association of immunoglobulin levels, infectious risk and mortality with rituximab. JAMA Netw. Оpen. 2018; 1(7): e184169. DOI: 10/1001/jamanetworkopen.2018.4169
8. Schioppo T., Ingegnoli F. Current perspective on rituximab in rheumatic diseases. Drug Des. Devel. Ther. 2017; 11: 2891–2904. DOI: 10.2147/DDDT.S139248
9. Verstappen G.M., van Nimwegen J.F., Vissink A., Kroese F.G.M. et al. The value of rituximab treatment in primary Sjögren's syndrome. Clin. Immunol. 2017; 182: 6271. DOI: 10.1016/j.clim.2017.05.002
10. Kridin K., Ahmed A.R. Post-rituximab immunoglobulin M (IgM) hypogammaglobulinemia. Autoimmunol. Rev. 2020; 19(3): 102466. DOI: 10.1016/j.autorev.2020.102466
11. Christou E.A.A., Giardino G., Worth A., Ladomenou F. Risk factors predisposing to the development of hypogammaglobulinemia and infections post-rituximab. Int. Rev. Immunol. 2017; 36(6): 352–9. DOI: 10.1080/08830185.2017.1346092
12. Moskalets O.V., Yazdovskiy V.V., Nikitina N.V. A case of selective immunoglobulin A deficiency associated with autoimmune gastritis. Almanac of Clinical Medicine. 2016; 44(6): 790–5 (in Russian). DOI: 10.18786/2072-0505-2016-44-6-790-795
13. Moskalets O.V. Immunoglobulin A and its selective deficiency. Kazan Medical Journal. 2017; 98(5): 809–13 (in Russian). DOI: 10.17750/KMJ2017-809
14. Kado R., Sanders G., McCune W.J. Diagnostic and therapeutic considerations in patients with hypogammaglobulinemia after rituximab therapy. Curr. Opin. Rheumatol. 2017; 29(3): 228–33. DOI: 10.1097/BOR.0000000000000377
15. Shah S., Jaggi K., Greenberg K., Geetha D. Immunoglobulin levels and infection risk with rituximab induction for anti-neutrophil cytoplasmic antibody-associated vasculitis. Clin. Kidney J. 2017; 10(4): 470–4. DOI: 10.1093/ckj/sfx014
16. Marco H., Smith R.M., Jones R.B., Guerry M.J. et al. The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease. BMC Mucoscelet. Disord. 2014; 15: 178. DOI: 10/1186/1471-2474-15-178
17. Einarsson J.T., Evert M., Geborek P., Saxne T. et al. Rituximab in clinical practice: dosage, drug adhehrnce, Ig levels, infections and drug antibodies. Clin. Rheumatol. 2017; 36(12): 2743–50. DOI: 10.1007/s10067-017-3848-6
Review
For citations:
Moskalets O.V. Selective Immunoglobulin A Deficiency that Developed in the Long-Term Period after Rituximab Therapy. Title. 2022;21(6):63-66. (In Russ.) https://doi.org/10.31550/1727-2378-2022-21-6-63-66
Views:
12
Email this article 