PT - JOURNAL ARTICLE AU - Su-Hyun Kim AU - Na Young Park AU - Ki Hoon Kim AU - Jae-Won Hyun AU - Ho Jin Kim TI - Rituximab-Induced Hypogammaglobulinemia and Risk of Infection in Neuromyelitis Optica Spectrum Disorders AID - 10.1212/NXI.0000000000001179 DP - 2022 Sep 01 TA - Neurology - Neuroimmunology Neuroinflammation PG - e1179 VI - 9 IP - 5 4099 - http://nn.neurology.org/content/9/5/e1179.short 4100 - http://nn.neurology.org/content/9/5/e1179.full SO - Neurol Neuroimmunol Neuroinflamm2022 Sep 01; 9 AB - Background and Objectives To investigate the frequency and predictors of hypogammaglobulinemia during long-term rituximab (RTX) treatment in patients with neuromyelitis optica spectrum disorder (NMOSD) and its association with infections.Methods We retrospectively reviewed the data of patients with NMOSD who received RTX through the maintenance regimen based on memory B-cell detection for at least 1 year from 2006 to 2021 at an institutional referral center for NMOSD.Results A total of 169 patients received a median of 10 courses (range 1–27) of RTX reinfusion after induction over a median of 8 (range, 1–15) years. Their mean serum immunoglobulin (Ig)G level began to decline significantly after 2 years of treatment, steadily declined at a rate of 2%–8% per year for the following 8 years, and then plateaued after 10 years. The proportion of patients with hypo-IgG (<6 g/L) increased from 1.2% after 1 year of treatment to 41% after 14 years of treatment. While being treated with RTX, 58 (34%) patients had 114 infections, of whom 14 (8%) patients had 15 severe infections. Multivariable logistic regression analyses identified duration of RTX treatment in years (odds ratio [OR] 1.234, 95% confidence interval [CI] 1.015–1.502), mean annual RTX dose (OR 0.063, 95% CI 0.009–0.434), history of mitoxantrone (OR 3.318, 95% CI 1.109–9.93), hypo-IgG at baseline (OR 40.552, 95% CI 3.024–543.786), and body mass index >25 kg/m2 (OR 4.798, 95% CI 1.468–15.678) as independent predictors of hypo-IgG. The risk of infection during RTX treatment was independently associated with high Expanded Disability Status Scale scores (OR 1.427, 95% CI 1.2–1.697) and relapses during RTX treatment (OR 1.665, 95% CI 1.112–2.492), but not with hypogammaglobulinemia.Discussion Over 14 years of long-term RTX treatment, IgG levels gradually decreased, and the frequency of hypo-IgG increased to 41% of the patients. Patients with prolonged memory B-cell depletion after RTX, previous mitoxantrone history, hypo-IgG at baseline, or obesity were at risk of developing RTX-induced hypogammaglobulinemia. Nevertheless, infection rates remained low during treatment, and reduced immunoglobulin levels were not associated with an increased incidence of infections.BMI=body mass index; CNS-ID=CNS-inflammatory disease; CVID=common variable immune deficiency; EDSS=Expanded Disability Status Scale; HBS=hepatitis B surface; Ig=immunoglobulin; IQR=interquartile range; MS=multiple sclerosis; OR=odds ratio; PY=patient-year; SIE=severe infection event; UTI=urinary tract infection