The article “Risk of Severe Infections Associated with Immunoglobulin Deficiency Under Rituximab Therapy in Immune Mediated Inflammatory Diseases” by Claire Rempenault and colleagues evaluates the connection between severe infections and immunoglobulin deficiency in patients treated with Rituximab (RTX) for various autoimmune diseases. This study was conducted at the CHU Montpellier and included patients who had received at least one RTX infusion and had their immunoglobulin levels tested.

Key findings include:

• Out of 311 patients, 29 had prevalent immunoglobulin deficiency (already present before RTX treatment), and 68 developed this deficiency after starting RTX. Factors associated with acquiring immunoglobulin deficiency included longer RTX treatment, higher doses, specific types of immune diseases, and existing health conditions like diabetes and obesity.
• Forty-three patients experienced a severe infection within 12 months after their last RTX infusion. However, the study found no significant difference in infection rates between patients with or without immunoglobulin deficiency.
• The study concluded that while immunoglobulin deficiency occurred in some patients treated with RTX, it did not significantly increase the risk of severe infections. Management of RTX in patients with immunoglobulin deficiency should be tailored individually, considering other risk factors like concomitant steroid use and existing chronic pulmonary disease.

This research suggests that RTX treatment for autoimmune diseases does not inherently raise the risk of severe infections due to immunoglobulin deficiency, but patient-specific factors must be carefully managed.