Risk factors for severe bacterial infections in patients with systemic autoimmune diseases receiving rituximab

Details

Serval ID
serval:BIB_617BBA0072B5
Type
Article: article from journal or magazin.
Collection
Publications
Title
Risk factors for severe bacterial infections in patients with systemic autoimmune diseases receiving rituximab
Journal
Clin Rheumatol
Author(s)
Heusele M., Clerson P., Guery B., Lambert M., Launay D., Lefevre G., Morell-Dubois S., Maillard H., Le Gouellec N., Hatron P. Y., Hachulla E.
ISSN
1434-9949 (Electronic)
ISSN-L
0770-3198
Publication state
Published
Issued date
06/2014
Volume
33
Number
6
Pages
799-805
Language
english
Notes
Heusele, Marion
Clerson, Pierre
Guery, Benoit
Lambert, Marc
Launay, David
Lefevre, Guillaume
Morell-Dubois, Sandrine
Maillard, Helene
Le Gouellec, Noemie
Hatron, Pierre-Yves
Hachulla, Eric
eng
Germany
Clin Rheumatol. 2014 Jun;33(6):799-805. doi: 10.1007/s10067-014-2509-2. Epub 2014 Feb 2.
Abstract
The risk of serious bacterial infectious events (SIEs) after an RTX course used in severe and refractory cases of systemic autoimmune diseases (SAID) is well known. Risk factors for SIEs merit investigation. For this case-control study, data were collected in a single centre of internal medicine and included all patients who received rituximab (RTX) for SAID between 2005 and 2011 (rheumatoid arthritis was excluded). Sixty-nine patients with SAID received a total of 87 RTX courses. Thirteen SIEs were reported in 12 patients leading to death in 5 patients. Patients with a history of SIE were significantly older (63.6+/-18.8 vs 48.8+/-16.7; p=0.0091), suffered most frequently of diabetes mellitus (33.3% vs 5.3%, p=0.015), had a lower CD19 count (1.0+/-1.2/mm3 vs 3.9+/-7.2/mm3) and had most frequently a prednisone dose>15 mg/day (91.7% vs 47.7%) at the start of the first RTX course. The SIE rate was 18.7 per 100 patient-years. At the initiation of the RTX course, risk factors for SIEs were lower IgG levels (OR=0.87, 95%CI=0.77-0.99, p=0.03), lower CD19 count (OR=0.85, 95%CI=0.73-1.00) and creatinine clearance</=45 ml/min (OR=7.78, 95%CI=1.36-44.38, p=0.002). Conversely history of pneumococcal vaccination significantly decreased the risk of SIEs (OR=0.11, 95%CI=0.03-0.41, p=0.0009). Concomitant treatment with prednisone at a dose>15 mg/day significantly increased the SIE risk (OR=8.07, 95%CI=1.94-33.59, p=0.0004). SIEs are frequent in SAID treated with RTX, particularly in patients receiving high-dose corticosteroids, in patients with renal insufficiency and in patients with low IgG levels or a low CD19 count.
Keywords
Aged, Aged, 80 and over, Antibodies, Monoclonal, Murine-Derived/*adverse effects, Antirheumatic Agents/*adverse effects, Autoimmune Diseases/complications/*immunology/*microbiology, Bacterial Infections/*complications, Case-Control Studies, Dose-Response Relationship, Drug, Female, Humans, Immunoglobulin G/blood, Lupus Erythematosus, Systemic/complications/microbiology/therapy, Male, Middle Aged, Prednisone/administration & dosage, Risk Factors, Rituximab, Treatment Outcome, Vasculitis/complications/microbiology/therapy
Pubmed
Create date
29/04/2021 10:59
Last modification date
30/04/2021 6:38
Usage data