TY - JOUR
T1 - The Risk of Severe Infections Following Rituximab Administration in Patients With Autoimmune Kidney Diseases
T2 - Austrian ABCDE Registry Analysis
AU - Odler, Balazs
AU - Windpessl, Martin
AU - Krall, Marcell
AU - Steiner, Maria
AU - Riedl, Regina
AU - Hebesberger, Carina
AU - Ursli, Martin
AU - Zitt, Emanuel
AU - Lhotta, Karl
AU - Antlanger, Marlies
AU - Cejka, Daniel
AU - Gauckler, Philipp
AU - Wiesholzer, Martin
AU - Saemann, Marcus
AU - Rosenkranz, Alexander R
AU - Eller, Kathrin
AU - Kronbichler, Andreas
N1 - Publisher Copyright:
Copyright © 2021 Odler, Windpessl, Krall, Steiner, Riedl, Hebesberger, Ursli, Zitt, Lhotta, Antlanger, Cejka, Gauckler, Wiesholzer, Saemann, Rosenkranz, Eller and Kronbichler.
PY - 2021/10/29
Y1 - 2021/10/29
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Austria/epidemiology
KW - Autoimmune Diseases/drug therapy
KW - Body Mass Index
KW - Female
KW - Humans
KW - Immunologic Factors/administration & dosage
KW - Incidence
KW - Infections/epidemiology
KW - Kaplan-Meier Estimate
KW - Kidney Diseases/drug therapy
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Registries
KW - Retrospective Studies
KW - Risk Factors
KW - Rituximab/administration & dosage
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85119063439&partnerID=8YFLogxK
U2 - 10.3389/fimmu.2021.760708
DO - 10.3389/fimmu.2021.760708
M3 - Journal article
C2 - 34777374
VL - 12
SP - 760708
JO - Frontiers in Immunology
JF - Frontiers in Immunology
M1 - 760708
ER -