The Risk of Severe Infections Following Rituximab Administration in Patients With Autoimmune Kidney Diseases: Austrian ABCDE Registry Analysis

Balazs Odler, Martin Windpessl, Marcell Krall, Maria Steiner, Regina Riedl, Carina Hebesberger, Martin Ursli, Emanuel Zitt, Karl Lhotta, Marlies Antlanger, Daniel Cejka, Philipp Gauckler, Martin Wiesholzer, Marcus Saemann, Alexander R Rosenkranz, Kathrin Eller, Andreas Kronbichler

Research output: Journal article (peer-reviewed)Journal article

5 Citations (Scopus)

Abstract

Objective: To characterize the incidence, type, and risk factors of severe infections (SI) in patients with autoimmune kidney diseases treated with rituximab (RTX).

Methods: We conducted a multicenter retrospective cohort study of adult patients with immune-related kidney diseases treated with at least one course of RTX between 2015 and 2019. As a part of the ABCDE Registry, detailed data on RTX application and SI were collected. SI were defined by Common Terminology Criteria for Adverse Events v5.0 as infectious complications grade 3 and above. Patients were dichotomized between "nephrotic" and "nephritic" indications. The primary outcome was the incidence of SI within 12 months after the first RTX application.

Results: A total of 144 patients were included. Twenty-five patients (17.4%) presented with SI, mostly within the first 3 months after RTX administration. Most patients in the nephritic group had ANCA-associated vasculitis, while membranous nephropathy was the leading entity in the nephrotic group. Respiratory infections were the leading SI (n= 10, 40%), followed by urinary tract (n=3, 12%) and gastrointestinal infections (n=2, 8%). On multivariable analysis, body mass index (BMI, 24.6 kg/m2 versus 26.9 kg/m2, HR: 0.88; 95%CI: 0.79-0.99; p=0.039) and baseline creatinine (HR: 1.25; 95%CI: 1.04-1.49; p=0.017) were significantly associated with SI. All patients in the nephritic group (n=19; 100%) who experienced a SI received oral glucocorticoid (GC) treatment at the time of infection. Hypogammaglobulinemia was frequent (58.5%) but not associated with SI.

Conclusions: After RTX administration, impaired kidney function and lower BMI are independent risk factors for SI. Patients with nephritic glomerular diseases having concomitant GC treatment might be at higher risk of developing SI.

Original languageEnglish
Article number760708
Pages (from-to)760708
JournalFrontiers in Immunology
Volume12
DOIs
Publication statusPublished - 29 Oct 2021

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Austria/epidemiology
  • Autoimmune Diseases/drug therapy
  • Body Mass Index
  • Female
  • Humans
  • Immunologic Factors/administration & dosage
  • Incidence
  • Infections/epidemiology
  • Kaplan-Meier Estimate
  • Kidney Diseases/drug therapy
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Rituximab/administration & dosage
  • Young Adult

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