In a nutshell
This study looked at the effect of rituximab (Rituxan) treatment on the immune system in patients with rheumatoid arthritis. The authors concluded that prolonged treatment with rituximab can lower patients’ immune responses and increase the risk of serious infection.
Biological drugs are becoming more popular as a treatment for rheumatoid arthritis (RA). Rituximab is one such drug that works by blocking the activity of immune cells. This then reduces the high level of inflammation seen in the joints of RA patients. Longer courses of treatment are needed for rituximab to be completely effective.
This prolonged treatment can weaken a patient’s immune response and can lead to a condition called hypogammaglobulinemia. This is an immune disorder where the body’s antibody levels are severely reduced, which increases the risk of serious infections.
Methods & findings
The authors looked at a number of different studies examining the effect of rituximab treatment on the immune system of RA patients.
One study including 1,300 RA patients treated with rituximab showed 82 severe infections in 78 patients during a 1.2 year follow up. Patients who had low levels of antibodies before beginning treatment were 4.8 times more likely to develop severe infections.
In another study of 3595 RA patients, there was no increase in infection rates in rituximab treated patients compared to other therapies. However, this study showed a link between the severity of hypogammaglobulinemia and the risk of serious infection.
Another study showed that serious infection rates are significantly higher in RA patients treated with a combination of rituximab and methotrexate (Rheumatrex) compared to treatment with rituximab on its own.
The bottom line
This study concluded that rituximab treatment can lower a patient’s immune response. This can lead to serious infections, particularly in patients with pre-existing hypogammaglobulinemia. The authors suggested that antibody levels be measured before and regularly throughout treatment.
The fine print
These conclusions were made based on a number of different studies with inconstant test methods and outcomes.
Consult with your physician if you have concerns about side effects related to your treatment.
Published By :
Current Opinion in Rheumatology
May 01, 2016
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