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

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 increa...

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Autores principales: Wijetilleka, Sonali, Jayne, David, Mukhtyar, Chetan, Karim, Mohammed Yousuf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667775/
https://www.ncbi.nlm.nih.gov/pubmed/31413852
http://dx.doi.org/10.1136/lupus-2019-000337
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author Wijetilleka, Sonali
Jayne, David
Mukhtyar, Chetan
Karim, Mohammed Yousuf
author_facet Wijetilleka, Sonali
Jayne, David
Mukhtyar, Chetan
Karim, Mohammed Yousuf
author_sort Wijetilleka, Sonali
collection PubMed
description 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.
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spelling pubmed-66677752019-08-14 Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases Wijetilleka, Sonali Jayne, David Mukhtyar, Chetan Karim, Mohammed Yousuf Lupus Sci Med Brief Communication 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. BMJ Publishing Group 2019-07-30 /pmc/articles/PMC6667775/ /pubmed/31413852 http://dx.doi.org/10.1136/lupus-2019-000337 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Brief Communication
Wijetilleka, Sonali
Jayne, David
Mukhtyar, Chetan
Karim, Mohammed Yousuf
Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases
title Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases
title_full Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases
title_fullStr Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases
title_full_unstemmed Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases
title_short Iatrogenic antibody deficiency from B-cell targeted therapies in autoimmune rheumatic diseases
title_sort iatrogenic antibody deficiency from b-cell targeted therapies in autoimmune rheumatic diseases
topic Brief Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667775/
https://www.ncbi.nlm.nih.gov/pubmed/31413852
http://dx.doi.org/10.1136/lupus-2019-000337
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