Risk factors for severe bacterial infections in patients with systemic autoimmune diseases receiving rituximabReport as inadecuate




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Clinical Rheumatology

, Volume 33, Issue 6, pp 799–805

First Online: 02 February 2014Received: 30 October 2013Revised: 12 January 2014Accepted: 19 January 2014

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-mm vs 3.9 ± 7.2-mm 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.

KeywordsInfectious risk Rituximab Systemic autoimmune diseases Systemic lupus erythematosus Vasculitis  Download fulltext PDF



Author: Marion Heusele - Pierre Clerson - Benoit Guery - Marc Lambert - David Launay - Guillaume Lefevre - Sandrine Morell-Dubois -

Source: https://link.springer.com/



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