Predictors of hypogammaglobulinemia and serious infections among patients receiving ocrelizumab or rituximab for treatment of MS and NMOSD

被引:12
|
作者
Mears, Veronica [1 ]
Jakubecz, Collin [2 ]
Seeco, Catherine [3 ]
Woodson, Sophia [4 ]
Serra, Alessandro [5 ]
Abboud, Hesham [6 ]
机构
[1] Univ Hosp Cleveland Med Ctr, Dept Pharm Serv, Cleveland, OH USA
[2] Univ Hosp Home Care Serv, Dept Specialty Pharm, Warrensville Hts, OH USA
[3] Univ Hosp Home Care Serv, Dept Specialty Pharm, Warrensville Hts, OH USA
[4] Univ Hosp Cleveland Med Ctr, Neurol & Neuroimmunol, Cleveland, OH USA
[5] Univ Hosp Cleveland Med Ctr, VA Multiple Sclerosis Ctr Excellence, Case Western Reserve Sch Med, Multiple Sclerosis & Neuroimmunol Program, Cleveland, OH USA
[6] Case Western Reserve Univ, Parkinsons & Movement Disorders Ctr, Multiple Sclerosis & Neuroimmunol Program, Neurol,Sch Med, 11100 Euclid Ave,Bolwell 5, Cleveland, OH 44106 USA
关键词
Multiple sclerosis; Nmosd; Infection; Rituximab; ocrelizumab; Hypogammaglobulinemia;
D O I
10.1016/j.jneuroim.2023.578066
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background and objectives: Ocrelizumab and rituximab are monoclonal antibodies targeting the CD20 marker on B lymphocytes. The enhanced efficacy of B lymphocyte depleting therapies poses a greater risk of decreased immunoglobulin (Ig) levels. The rate and risk factors of hypogammaglobulinemia in MS and NMOSD patients treated with anti-CD20 therapies are unknown.Methods: A retrospective study was conducted among patients who received anti-CD20 therapy for the treatment of MS, NMOSD, and other related neurological disorders. The goal was to determine the incidence and risk factors of hypogammaglobulinemia and serious infections in patients receiving ocrelizumab versus rituximab. The secondary goals were to determine the rates of lymphopenia, neutropenia, and early B cell repopulation among patients on anti-CD20 therapy.Results: Overall, 184 patients (mean age 48.4 +/- 13.7, 66.8% female) met inclusion criteria; 152 patients received ocrelizumab and 32 patients received rituximab. A total of 22 patients (12%) developed hypogammaglobulin-emia. Patients who developed hypogammaglobulinemia were more likely to have been >= 50 years of age (p = .0275) with lower baseline IgG (p = .001) and IgA (p = .0038) levels. Serious infections were observed in 21 patients (11%) and seen more commonly in those that developed total lymphopenia (<1.0 x 109/L) and had longer duration of B-cell therapy. Multivariate analysis identified age >= 50 years, white race, and rituximab as independent predictors of hypogammaglobulinemia, and absolute lymphopenia as an independent risk factor for serious infections.Discussion: Among patients receiving anti-CD20 therapy, 12% of patients experienced hypogammaglobulinemia which was seen more commonly in white patients, at least 50 years old, with lower baseline IgG and IgA levels and in those treated with rituximab. Serious infections were seen more commonly in patients with total lym-phopenia and longer exposure to anti-CD20 therapy.
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页数:7
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