{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:21:03Z","timestamp":1791580863126,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rituximab is effective and widely used as long\u2010term treatment in aquaporin\u20104\u2010IgG\u2010positive neuromyelitis optica spectrum disorder (AQP4\u2010IgG+ NMOSD). However, infections remain a significant concern during rituximab treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective multicenter cohort study within the NMO Study Group (NEMOS) in Germany, analyzing demographic and clinical data from people with AQP4\u2010IgG+ NMOSD receiving rituximab or azathioprine by retrospective chart, and compared infection occurrence and severity. For rituximab\u2010treated patients, we collected laboratory data (blood lymphocytes, B\u2010cell counts, serum IgG, IgM, and IgA levels), assessed risk factors for infections, and determined the probability of infection within a 3\u2010month window before and after the laboratory assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 92\/170 rituximab and in 12\/33 azathioprine treatment episodes, one or more infections were documented. Rituximab and azathioprine showed comparable types and risk of infection (HR\u2009=\u20091.24, 95% CI: 0.68\u20132.25). Rituximab\u2010treated individuals older than 60\u2009years had a higher risk of infection (HR\u2009=\u20091.62, 95% CI: 1.02\u20132.57). Hypogammaglobulinemia (IgG &lt;\u20096.0\u2009g\/L: OR\u2009=\u20092.27, 95% CI: 1.15\u20134.48; IgM &lt;\u20090.3\u2009g\/L: OR\u2009=\u20092.08, 95% CI: 1.05\u20134.09) predicted infections and the occurrence of both low IgG and IgM serum levels further increased the risk of infection (OR\u2009=\u20092.77, 95% CI: 1.10\u20136.98) during rituximab treatment. Low IgG and IgA serum levels as well as lymphopenia predicted infection\u2010related hospitalizations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Age &gt;\u200960\u2009years and immunoglobulin serum levels during rituximab treatment may serve as predictors for infection and help to individualize treatment decisions in NMOSD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70520","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T18:32:46Z","timestamp":1770229966000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Age, Low Immunoglobulin G, and M Serum Levels Predict Infections in People With\n                    <scp>AQP4<\/scp>\n                    \u2010\n                    <scp>IgG<\/scp>\n                    +\n                    <scp>NMOSD<\/scp>\n                    Treated With Rituximab\u2014A Multicenter Cohort Study From the German Neuromyelitis Optica Study Group (\n                    <scp>NEMOS<\/scp>\n                    )"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9877-6987","authenticated-orcid":false,"given":"Daniel","family":"Engels","sequence":"first","affiliation":[{"name":"Institute of Clinical Neuroimmunology and Biomedical Center (BMC) LMU University Hospital, Faculty of Medicine, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariella","family":"Herfurth","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Leipzig  Leipzig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Havla","sequence":"additional","affiliation":[{"name":"Institute of Clinical Neuroimmunology and Biomedical Center (BMC) LMU University Hospital, Faculty of Medicine, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Schindler","sequence":"additional","affiliation":[{"name":"Department of Neurology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klemens","family":"Ruprecht","sequence":"additional","affiliation":[{"name":"Department of Neurology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Schwake","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef Hospital Ruhr University  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Ringelstein","sequence":"additional","affiliation":[{"name":"Department of Neurology Centre for Neurology and Neuropsychiatry, LVR\u2010Klinikum, Heinrich Heine University  D\u00fcsseldorf Germany"},{"name":"Department of Neurology Medical Faculty and University Hospital, Heinrich Heine University  D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katinka","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical Faculty and University Hospital, Heinrich Heine University  D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2967-4290","authenticated-orcid":false,"given":"Charlotte","family":"Schubert","sequence":"additional","affiliation":[{"name":"Department of Neurology and Institute of Neuroimmunology and MS (INIMS) University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8315-5398","authenticated-orcid":false,"given":"Insa","family":"Schiffmann","sequence":"additional","affiliation":[{"name":"Department of Neurology and Institute of Neuroimmunology and MS (INIMS) University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin W.","family":"H\u00fcmmert","sequence":"additional","affiliation":[{"name":"Department of Neurology Hannover Medical School  Hannover Germany"},{"name":"Department of Neurology Klinikum Agnes Karll Laatzen\/Klinikum Region Hannover  Laatzen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Giglhuber","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine and Health Technical University Munich, Klinikum Rechts der Isar  Munich 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Delbr\u00fcck Center for Molecular Medicine in the Helmholtz Association and Charit\u00e9 Universit\u00e4tsmedizin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian Then","family":"Bergh","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Leipzig  Leipzig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7509-5268","authenticated-orcid":false,"given":"Tania","family":"K\u00fcmpfel","sequence":"additional","affiliation":[{"name":"Institute of Clinical Neuroimmunology and Biomedical Center (BMC) LMU University Hospital, Faculty of Medicine, LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Neuromyelitis Optica Study Group 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