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
Clinical rheumatology
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
Peer-reviewed
Oui
Volume
33
Number
6
Pages
799-805
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
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, Autoimmune Diseases/immunology, Autoimmune Diseases/microbiology, Bacterial Infections/complications, Case-Control Studies, Dose-Response Relationship, Drug, Female, Humans, Immunoglobulin G/blood, Lupus Erythematosus, Systemic/complications, Lupus Erythematosus, Systemic/microbiology, Lupus Erythematosus, Systemic/therapy, Male, Middle Aged, Prednisone/administration & dosage, Risk Factors, Rituximab, Treatment Outcome, Vasculitis/complications, Vasculitis/microbiology, Vasculitis/therapy
Pubmed
Web of science
Open Access
Yes
Create date
29/04/2021 9:59
Last modification date
17/07/2023 14:16
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