MANAGEMENT OF SECONDARY ANTIBODY DEFICIENCY WITH INTRAVENOUS IMMUNOGLOBULIN IN PATIENTS WITH PREVIOUS THERAPY WITH RITUXIMAB
- Javier Carbone, Spain
Abstract
Background and Aims
Rituximab can be associated with symptomatic secondary antibody deficiency (SAD) in autoimmune diseases (AID). Severe or recurrent infections can develop. There are no established guidelines for evaluating and treating SAD after Rituximab. Intravenous immunoglobulin (IVIG) replacement therapy has been poorly evaluated as treatment for SAD in AID.
Methods
Retrospective analysis of prospectively collected data in a single center. 10 autoimmune disease patients [SLE (2), dermatomyositis (2), vasculitis (2), polymiositis (1), optic neuromyelitis (1), undifferentiated connective tissue disease (n=1), Wegener granulomatosis (1)] that developed severe infections and were found to have SAD after Rituximab. 7 (70%) were women, mean age 62 (39-79). SAD definition: IgG < 600 mg/dL + low anti-pneumococcal antibody titers (anti-PPS<5 mg/dL). Intervention: Non-specific 5% or 10% IVIG at a dose of 400mg/kg/month in addition to conventional antimicrobial therapy with the aims of contributing to control of infection, secondary prevention of re-infection and normalization of IgG (IgG>750 mg/dL). Time of IVIG therapy for analysis: 6 months. Clinical follow up: 6 months after the first dose of IVIG.
Results
A significant increase of IgG levels was demostrated: 865± 133 vs 542±68 mg/dL (p=0.02). A trend towards an increase of anti-PPS was observed: 3.86±1.44 vs 2.98±1.04 (p=0.12). The prevalence of infection was significantly lower during the IVIG period as compared with a similar period of time before IVIG: Infections 1±0.7 vs 3.8±0.8 (p<0.001).
Conclusions
Personalized immunoguided intervention of IVIG in autoimmune disease patients with SAD after Rituximab is associated with lower rates of reinfections. These results require evaluation in a randomized clinical trial.