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Management Strategies for Hypogammaglobulinemia Secondary to B-Cell–Depleting Therapies
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- Anti-CD20 monoclonal antibodies (B-cell–depleting therapies) are widely used to treat MS and related disorders. One main unwanted effect is the progressive hypogammaglobulinemia observed in some patients and, in some cases, the associated infections. There might be several strategies to mitigate the risk, including stopping treatment, reducing the dose or frequency, switching to another agent that has a different mechanism of action, or replacing immunoglobulins (using either an intravenous or subcutaneous route). In this retrospective study, the investigators examined the multiple modalities for risk mitigation. They found that replacing immunoglobulins is associated with the largest increase in immunoglobulin G levels per year and that dose reduction was associated with the largest decrease in the number of yearly infections. Dose or frequency reduction did not impact the efficacy of these agents, and this finding is consistent with previous reports on different dosing regimens for B-cell–depleting therapies.
- This study helps clinicians decide which risk-mitigation strategy to adopt in patients for whom reduced immunoglobulin G levels and increased numbers of infections are observed. Of note, it is also important to compare strategies based on costs and safety, as replacing immunoglobulins is costly, associated with thromboembolism and kidney injury, and not necessarily the best approach to reducing the frequency of infection. It is very important to re-evaluate the risks associated with and benefits of anti-CD20 therapy in each patient over time.
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Multiple Sclerosis Journal - Experimental, Translational and Clinical
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Hypogammaglobulinemia secondary to B-cell depleting therapies in neuroimmunology: Comparing management strategies
Mult Scler J Exp Transl Clin 2023 Jul 01;9(2)20552173231182534, H Kelly, A Vishnevetsky, LB Chibnik, M LevyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.