Serious Infectious Complications After Rituximab Therapy in Patients With Autoimmunity: Is This the Final Word?

Key Points Question In patients receiving rituximab, what are the current rates of screening and recognition of hypogammaglobulinemia, and what are the infectious risks and predictors for increased mortality? Findings In a cohort study of 4479 patients receiving rituximab, many patients were found as not being screened or not being properly identified as having hypogammaglobulinemia. Following rituximab therapy, there was a significant increase in severe infections in the overall study cohort, increased mortality was associated with severe infections in the 6 months before and after rituximab therapy, and higher cumulative doses of immunoglobulin replacement therapy were associated with a reduced risk of severe infections. Meaning Many patients are not being screened or properly identified as having hypogammaglobulinemia before or after rituximab therapy, which may contribute to inferior outcomes with excess morbidity and mortality; monitoring routine serum immunoglobulin levels before and after rituximab therapy may help identify patients at high risk for developing infections and who may benefit from immunoglobulin replacement therapy.