{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T17:25:34Z","timestamp":1757611534016,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T00:00:00Z","timestamp":1706486400000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,11,17]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We evaluated the risk of severe infection in patients with immune-mediated inflammatory disease (IMID) treated with RTX and with Ig deficiency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was an observational, retrospective single-centre study of patients undergoing treatment with at least one rituximab (RTX) infusion for an IMID until 31 May 2020. Patients were followed up for at least 12 months after the last infusion or until severe infection or death. Ig deficiency was classified as prevalent (before RTX) or acquired (normal Ig assay results before RTX but Ig deficiency during a follow-up).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 311 patients, 10.6% had prevalent and 19.6% acquired Ig deficiency. Prevalent Ig deficiency was related to concomitant treatment with glucocorticoids (GCs), in particular with a high daily dose at baseline; and acquired Ig deficiency to cumulative dose of RTX, mean Disease Activity Score in 28 joints (DAS28), immunosuppressor or GCs therapy at baseline, diabetes mellitus and obesity. Overall, 14.5% of patients had a severe infection during follow-up, which was numerically but not statistically more frequent in patients with prevalent Ig deficiency than normal Ig level. On multivariate analysis, risk of severe infection was associated with chronic pulmonary disease, GCs dose and mean DAS28-C reactive protein. In a time-dependent analysis, risk of severe infection was not associated with Ig deficiency, either acquired or prevalent (adjusted HR 1.04 (95% CI 0.5 to 2.3), p=0.92).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Risk of severe infection was not associated with RTX-induced Ig deficiency in patients with an IMID. RTX management should be discussed according to an individual assessment of the infectious risk, especially in patients with GC therapy or chronic lung disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003415","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T23:15:24Z","timestamp":1706656524000},"page":"e003415","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of severe infection associated with immunoglobulin deficiency under rituximab therapy in immune-mediated inflammatory disease"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0083-0875","authenticated-orcid":false,"given":"Claire","family":"Rempenault","sequence":"first","affiliation":[{"name":"Rheumatology, CHU Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9dric","family":"Lukas","sequence":"additional","affiliation":[{"name":"Rheumatology, CHU Montpellier, Montpellier, France"},{"name":"UMR UA11 INSERM (IDESP), University of Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e9a","family":"Tardivon","sequence":"additional","affiliation":[{"name":"Rheumatology, CHU Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7287-9320","authenticated-orcid":false,"given":"Claire Immediato","family":"Daien","sequence":"additional","affiliation":[{"name":"Rheumatology, CHU Montpellier, Montpellier, France"},{"name":"INSERM, CNRS, University of Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4002-1861","authenticated-orcid":false,"given":"Bernard","family":"Combe","sequence":"additional","affiliation":[{"name":"Rheumatology, CHU Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Guilpain","sequence":"additional","affiliation":[{"name":"Internal Medicine and Multi-Organic Diseases, CHU Montpellier, Montpellier, France"},{"name":"IRMB, INSERM, University of Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7545-6385","authenticated-orcid":false,"given":"Jacques","family":"Morel","sequence":"additional","affiliation":[{"name":"Rheumatology, CHU Montpellier, Montpellier, France"},{"name":"INSERM, CNRS, University of Montpellier, Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"2025090313564158000_10.1.e003415.1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2019.01990","article-title":"Systematic review of safety and efficacy of Rituximab in treating immune-mediated disorders","volume":"10","author":"Kaegi","year":"2019","journal-title":"Front Immunol"},{"key":"2025090313564158000_10.1.e003415.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2009.07718.x"},{"key":"2025090313564158000_10.1.e003415.3","doi-asserted-by":"publisher","DOI":"10.2217\/imt-2017-0178"},{"key":"2025090313564158000_10.1.e003415.4","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090856"},{"key":"2025090313564158000_10.1.e003415.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker417"},{"key":"2025090313564158000_10.1.e003415.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2014.11.009"},{"key":"2025090313564158000_10.1.e003415.7","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1080\/08830185.2017.1346092","article-title":"Risk factors predisposing to the development of Hypogammaglobulinemia and infections post-Rituximab","volume":"36","author":"Christou","year":"2017","journal-title":"Int Rev Immunol"},{"key":"2025090313564158000_10.1.e003415.8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jaut.2019.01.011","article-title":"Primary immunodeficiency and Autoimmunity: A comprehensive review","volume":"99","author":"Amaya-Uribe","year":"2019","journal-title":"J Autoimmun"},{"key":"2025090313564158000_10.1.e003415.9","doi-asserted-by":"publisher","DOI":"10.1002\/art.23059"},{"key":"2025090313564158000_10.1.e003415.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.119933"},{"key":"2025090313564158000_10.1.e003415.11","doi-asserted-by":"publisher","DOI":"10.1002\/art.27555"},{"key":"2025090313564158000_10.1.e003415.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2018.02.010"},{"key":"2025090313564158000_10.1.e003415.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2474-15-178","article-title":"The effect of Rituximab therapy on immunoglobulin levels in patients with Multisystem autoimmune disease","volume":"15","author":"Marco","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"2025090313564158000_10.1.e003415.14","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1002\/acr.20318","article-title":"Safety and efficacy of Rituximab in Nonviral Cryoglobulinemia vasculitis: data from the French Autoimmunity and Rituximab Registry","volume":"62","author":"Terrier","year":"2010","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313564158000_10.1.e003415.15","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1002\/art.40937","article-title":"Predicting severe infection and effects of Hypogammaglobulinemia during therapy with Rituximab in rheumatic and musculoskeletal diseases","volume":"71","author":"Md Yusof","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2025090313564158000_10.1.e003415.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2017.11.015"},{"key":"2025090313564158000_10.1.e003415.17","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2025090313564158000_10.1.e003415.18","doi-asserted-by":"crossref","first-page":"102505","DOI":"10.1016\/j.autrev.2020.102505","article-title":"Severe infections in patients with anti-neutrophil cytoplasmic antibody-associated Vasculitides receiving Rituximab: A meta-analysis","volume":"19","author":"Thery-Casari","year":"2020","journal-title":"Autoimmun Rev"},{"key":"2025090313564158000_10.1.e003415.19","doi-asserted-by":"crossref","first-page":"845","DOI":"10.2147\/DDDT.S195113","article-title":"Clinical efficacy and safety of Rituximab in lupus nephritis","volume":"13","author":"Zhong","year":"2019","journal-title":"Drug Des Devel Ther"},{"key":"2025090313564158000_10.1.e003415.20","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-12-396028"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2023-003415","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:56:48Z","timestamp":1756933008000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2023-003415"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,30]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/rmdopen-2023-003415"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2023-003415","relation":{},"ISSN":["2056-5933"],"issn-type":[{"type":"electronic","value":"2056-5933"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}