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Risk of hypogammaglobulinemia and rituximab

Dr Susanna Hallberg, Karolinska Institute, Sweden

Rituximab, an anti-CD20-therapy that depletes B cells with high efficacy and tolerability, is used off-label for MS (in Sweden) [1]. From studies in rheumatology [2] and in other autoimmune diseases, such as neuromyelitis optica spectrum disorders [3], hypogammaglobulinemia is a well-known side effect associated with rituximab which can lead to treatment discontinuation and susceptibility for infections.

Dr Susanna Hallberg (Karolinska Institute, Sweden) and colleagues investigated the risk of developing decreased levels of IgG and IgM during long-term treatment with rituximab in MS patients (n=1,933). They found that the risk of hypogammaglobulinemia is an important side-effect in long-term treatment with rituximab in MS, which is consistent with previous findings in other autoimmune diseases [2,3].

The main predictors for treatment-induced Ig decrease were total accumulated dose of rituximab, treatment duration, and initial level of IgG. IgG level...

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