{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:15:54Z","timestamp":1793164554592,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T00:00:00Z","timestamp":1569456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000659","name":"Research Trainees Coordinating Centre","doi-asserted-by":"publisher","award":["DRF\u20102014\u201007\u2010155"],"award-info":[{"award-number":["DRF\u20102014\u201007\u2010155"]}],"id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis & Rheumatology"],"published-print":{"date-parts":[[2019,11]]},"abstract":"Objective<\/jats:title>To evaluate predictors of serious infection events (SIE<\/jats:styled-content>s) during rituximab (RTX<\/jats:styled-content>) therapy and effects of hypogammaglobulinemia on SIE<\/jats:styled-content> rates, and humoral response and its persistence after discontinuation of RTX<\/jats:styled-content> in the treatment of rheumatic and musculoskeletal diseases (RMD<\/jats:styled-content>s).<\/jats:p><\/jats:sec>Methods<\/jats:title>A retrospective longitudinal study of 700 RMD<\/jats:styled-content> patients treated with RTX<\/jats:styled-content> in a single center was conducted. Immunoglobulin levels were measured at baseline and at 4\u20136 months after each treatment cycle. Baseline predictors of SIE<\/jats:styled-content>s were assessed using multivariable logistic regression; for RTX<\/jats:styled-content> cycles 2\u20134, a mixed\u2010effects logistic regression model was used.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 507 patients (72%) had rheumatoid arthritis, 94 (13%) had systemic lupus erythematosus, 49 (7%) had antineutrophil cytoplasmic antibody\u2013associated vasculitis, and 50 (7%) had other RMD<\/jats:styled-content>s. The number of SIE<\/jats:styled-content>s recorded was 281 in 176 patients (9.8 per 100 person\u2010years). Predictors of SIE<\/jats:styled-content>s included non\u2013RTX<\/jats:styled-content>\u2010specific comorbidities (previous history of SIE<\/jats:styled-content>, cancer, chronic lung disease, diabetes mellitus, and heart failure), higher corticosteroid dose, and RTX<\/jats:styled-content>\u2010specific factors, including low IgG (<6 gm\/liter) both at baseline and during treatment, RTX<\/jats:styled-content>\u2010associated neutropenia, higher IgM, and longer time to RTX<\/jats:styled-content> re\u2010treatment, but not B cell count or depletion status. Of 110 patients with low IgG, SIE<\/jats:styled-content> rates were higher in those with low IgG at baseline (16.4 per 100 person\u2010years) and in those who acquired low IgG during or after RTX<\/jats:styled-content> treatment (21.3 per 100 person\u2010years) versus those with normal IgG (9.7 per 100 person\u2010years). Five of 8 patients (63%) had impaired humoral response to pneumococcus and hemophilus following vaccination challenge, and only 4 of 11 patients (36%) had IgG normalized after switching biologic disease\u2010modifying antirheumatic drugs.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Immunoglobulin levels should be monitored at baseline and before each RTX<\/jats:styled-content> cycle to identify patients at risk of SIE<\/jats:styled-content>s. Individualized risk\u2013benefit assessment should be undertaken in those with lower IgG as this is a consistent SIE<\/jats:styled-content> predictor and may increase infection profiles when RTX<\/jats:styled-content> is switched to different therapies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.40937","type":"journal-article","created":{"date-parts":[[2019,5,27]],"date-time":"2019-05-27T07:52:56Z","timestamp":1558943576000},"page":"1812-1823","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":117,"title":["Predicting Severe Infection and Effects of Hypogammaglobulinemia During Therapy With Rituximab in Rheumatic and Musculoskeletal Diseases"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-9121","authenticated-orcid":false,"given":"Md Yuzaiful","family":"Md Yusof","sequence":"first","affiliation":[{"name":"University of Leeds Chapel Allerton Hospital NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1637-4755","authenticated-orcid":false,"given":"Edward M.","family":"Vital","sequence":"additional","affiliation":[{"name":"University of Leeds Chapel Allerton Hospital NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien M.","family":"McElvenny","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5245-4755","authenticated-orcid":false,"given":"Elizabeth M. 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