Hypogammaglobulinaemia during rituximab treatment in multiple sclerosis: a Swedish cohort study

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Hypogammaglobulinaemia during rituximab treatment in multiple sclerosis : a Swedish cohort study

Hallberg, Susanna (author): Department of Clinical Sciences, Karolinska Institutet, Danderyds Sjukhus, Stockholm, Sweden

Evertsson, Björn (author): Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Lillvall, Ellen (author): Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Boremalm, Malin (author): Umeå universitet,Neurovetenskaper

de Flon, Pierre, 1966- (author): Umeå universitet,Neurovetenskaper

Wang, Yunzhang (author): Department of Clinical Sciences, Karolinska Institutet, Danderyds Sjukhus, Stockholm, Sweden

Salzer, Jonatan (author): Umeå universitet,Neurovetenskaper

Lycke, Jan (author): Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Fink, Katharina (author): Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Frisell, Thomas (author): Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden

Al Nimer, Faiez (author): Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Svenningsson, Anders (author): Department of Clinical Sciences, Karolinska Institutet, Danderyds Sjukhus, Stockholm, Sweden

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2024
2024
English.
In: European Journal of Neurology. - : John Wiley & Sons. - 1351-5101 .- 1468-1331.

Related links:: https://doi.org/10.1...; show more...; https://umu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background and purpose: Mechanisms behind hypogammaglobulinaemia during rituximab treatment are poorly understood.Methods: In this register-based multi-centre retrospective cohort study of multiple sclerosis (MS) patients in Sweden, 2745 patients from six participating Swedish MS centres were identified via the Swedish MS registry and included between 14 March 2008 and 25 January 2021. The exposure was treatment with at least one dose of rituximab for MS or clinically isolated syndrome, including data on treatment duration and doses. The degree of yearly decrease in immunoglobulin G (IgG) and immunoglobulin M (IgM) levels was evaluated.Results: The mean decrease in IgG was 0.27 (95% confidence interval 0.17–0.36) g/L per year on rituximab treatment, slightly less in older patients, and without significant difference between sexes. IgG or IgM below the lower limit of normal (<6.7 or <0.27 g/L) was observed in 8.8% and 8.3% of patients, respectively, as nadir measurements. Six out of 2745 patients (0.2%) developed severe hypogammaglobulinaemia (IgG below 4.0 g/L) during the study period. Time on rituximab and accumulated dose were the main predictors for IgG decrease. Previous treatment with fingolimod and natalizumab, but not teriflunomide, dimethyl fumarate, interferons or glatiramer acetate, were significantly associated with lower baseline IgG levels by 0.80–1.03 g/L, compared with treatment-naïve patients. Switching from dimethyl fumarate or interferons was associated with an additional IgG decline of 0.14–0.19 g/L per year, compared to untreated.Conclusions: Accumulated dose and time on rituximab treatment are associated with a modest but significant decline in immunoglobulin levels. Previous MS therapies may influence additional IgG decline.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)

Keyword

disease-modifying therapy
hypogammaglobulinaemia
IgG decrease
IgM decrease
immunoglobulin decrease
multiple sclerosis
real-world data
rituximab therapy

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By the author/editor: Hallberg, Susann ...; Evertsson, Björn; Lillvall, Ellen; Boremalm, Malin; de Flon, Pierre, ...; Wang, Yunzhang; show more...; Salzer, Jonatan; Lycke, Jan; Fink, Katharina; Frisell, Thomas; Al Nimer, Faiez; Svenningsson, An ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Neurology

Articles in the publication: European Journal ...

By the university: Umeå University

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