Sonali Wijetilleka1, Chetan Mukhtyar2, David Jayne3, Aftab Ala4, Philip Bright5, Hector Chinoy6, Lorraine Harper7, Majid Kazmi8, Sorena Kiani-Alikhan9, Charles Li10, Siraj Misbah11, Louise Oni12, Fiona Price-Kuehne13, Alan Salama14, Sarita Workman15, David Wrench16, Mohammed Yousuf Karim17. 1. Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, UK. Electronic address: sonaliwijetilleka@doctors.org.uk. 2. Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK. Electronic address: chetan.mukhtyar@nnuh.nhs.uk. 3. Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK. Electronic address: dj106@cam.ac.uk. 4. Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK. Electronic address: aftabala@nhs.net. 5. Department of Immunology, North Bristol NHS Trust, Bristol, UK. Electronic address: phil.bright@nhs.net. 6. Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK. Electronic address: Hector.Chinoy@manchester.ac.uk. 7. Department of Nephrology, Institute of Clinical Sciences, College of Medical and Dental Science, University of Birmingham, Birmingham, UK. Electronic address: l.harper@bham.ac.uk. 8. Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: majid.kazmi@gstt.nhs.uk. 9. Department of Immunology, Barts and The London NHS Trust, London, UK. Electronic address: skiani@nhs.net. 10. Department of Rheumatology, Royal Surrey County Hospital, Guildford, UK. Electronic address: charles.li@nhs.net. 11. Department of Immunology, Oxford University Hospitals, Oxford, UK. Electronic address: siraj.misbah@ouh.nhs.uk. 12. Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK. Electronic address: Louise.Oni@liverpool.ac.uk. 13. Department of Paediatrics, University of Cambridge School of Clinical Medicine, Cambridge, UK. Electronic address: fep30@cam.ac.uk. 14. Department of Nephrology, University College London Centre for Nephrology, Royal Free Hospital, London, UK. Electronic address: a.salama@ucl.ac.uk. 15. Department of Immunology, Royal Free London NHS Foundation Trust, London, UK. Electronic address: sarita.workman@nhs.net. 16. Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK. Electronic address: david.wrench@gstt.nhs.uk. 17. Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, UK. Electronic address: youshimmi@gmail.com.
Abstract
BACKGROUND: Consensus guidelines are not available for the use of immunoglobulin replacement therapy (IGRT) in patients developing iatrogenic secondary antibody deficiency following B-cell targeted therapy (BCTT) in autoimmune rheumatic disease. OBJECTIVES: To evaluate the role of IGRT to manage hypogammaglobulinemia following BCTT in autoimmune rheumatic disease (AIRD). METHODS: Using an agreed search string we performed a systematic literature search on Medline with Pubmed as vendor. We limited the search to English language papers with abstracts published over the last 10 years. Abstracts were screened for original data regarding hypogammaglobulinemia following BCTT and the use of IGRT for hypogammaglobulinemia following BCTT. We also searched current recommendations from national/international organisations including British Society for Rheumatology, UK Department of Health, American College of Rheumatology, and American Academy of Asthma, Allergy and Immunology. RESULTS: 222 abstracts were identified. Eight papers had original relevant data that met our search criteria. These studies were largely retrospective cohort studies with small patient numbers receiving IGRT. The literature highlights the induction of a sustained antibody deficiency, risk factors for hypogammaglobulinemia after BCTT including low baseline serum IgG levels, how to monitor patients for the development of hypogammaglobulinemia and the limited evidence available on intervention thresholds for commencing IGRT. CONCLUSION: The benefit of BCTT needs to be balanced against the risk of inducing a sustained secondary antibody deficiency. Consensus guidelines would be useful to enable appropriate assessment prior to and following BCTT in preventing and diagnosing hypogammaglobulinemia. Definitions for symptomatic hypogammaglobulinemia, intervention thresholds and treatment targets for IGRT, and its cost-effectiveness are required. Crown
BACKGROUND: Consensus guidelines are not available for the use of immunoglobulin replacement therapy (IGRT) in patients developing iatrogenic secondary antibody deficiency following B-cell targeted therapy (BCTT) in autoimmune rheumatic disease. OBJECTIVES: To evaluate the role of IGRT to manage hypogammaglobulinemia following BCTT in autoimmune rheumatic disease (AIRD). METHODS: Using an agreed search string we performed a systematic literature search on Medline with Pubmed as vendor. We limited the search to English language papers with abstracts published over the last 10 years. Abstracts were screened for original data regarding hypogammaglobulinemia following BCTT and the use of IGRT for hypogammaglobulinemia following BCTT. We also searched current recommendations from national/international organisations including British Society for Rheumatology, UK Department of Health, American College of Rheumatology, and American Academy of Asthma, Allergy and Immunology. RESULTS: 222 abstracts were identified. Eight papers had original relevant data that met our search criteria. These studies were largely retrospective cohort studies with small patient numbers receiving IGRT. The literature highlights the induction of a sustained antibody deficiency, risk factors for hypogammaglobulinemia after BCTT including low baseline serum IgG levels, how to monitor patients for the development of hypogammaglobulinemia and the limited evidence available on intervention thresholds for commencing IGRT. CONCLUSION: The benefit of BCTT needs to be balanced against the risk of inducing a sustained secondary antibody deficiency. Consensus guidelines would be useful to enable appropriate assessment prior to and following BCTT in preventing and diagnosing hypogammaglobulinemia. Definitions for symptomatic hypogammaglobulinemia, intervention thresholds and treatment targets for IGRT, and its cost-effectiveness are required. Crown
Authors: Huzaefah Syed; Christian Ascoli; Catharina Fm Linssen; Christen Vagts; Thomas Iden; Aamer Syed; Jordana Kron; Kelly Polly; David Perkins; Patricia W Finn; Richard Novak; Marjolein Drent; Robert Baughman; Nadera J Sweiss Journal: Sarcoidosis Vasc Diffuse Lung Dis Date: 2020-06-30 Impact factor: 0.670