Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases

Wijetilleka, Sonali, Jayne, David, Mukhtyar, Chetan and Karim, Mohammed Yousuf (2019) Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases. Lupus Science & Medicine, 6 (1). ISSN 2053-8790

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Abstract

B-cell targeted therapies (BCTT) are now widely used in autoimmune rheumatic diseases, including SLE, antineutrophil cytoplasmic antibody-associated vasculitis and rheumatoid arthritis. Early studies suggested that rituximab did not influence serum immunoglobulins. However, subsequently, with increased patient numbers, longer follow-up duration and many patients having received multiple BCTT courses, multiple subsequent studies have identified hypogammaglobulinaemia as a potential side effect. Patients developing hypogammaglobulinaemia appear to fit into two principal categories: the majority who develop transient, often mild reduction in immunoglobulins without increased infection and a much smaller but clinically significant group with a more sustained antibody deficiency, who display increased risk of infection. Monitoring immunoglobulin levels represents an opportunity for the early detection of hypogammaglobulinaemia, and the prevention of avoidable morbidity. In the two major studies, approximately 4%-5% of BCTT-treated patients required immunoglobulin replacement due to recurrent infections in the context of hypogammaglobulinaemia. Despite this, monitoring of immunoglobulins is suboptimal, and there remains a lack of awareness of hypogammaglobulinaemia as an important side effect.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 27 Nov 2019 01:59
Last Modified: 22 Apr 2020 08:23
URI: https://ueaeprints.uea.ac.uk/id/eprint/73082
DOI: 10.1136/lupus-2019-000337

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