Severe Infections following Rituximab Treatment in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Introduction: Severe infections were not rare in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients treated with rituximab. The current study aimed to evaluate severe infections in AAV patients received rituximab administration in a single Chinese center. Methods: Twenty-seven patients were retrospectively included in this study. Their demographic and clinical data were analyzed. Severe infections were classified as grade >= 3 as proposed by the Common Terminology Criteria for Adverse Events V.4.0. Results: Patients were followed up for 23.6 +/- 14.0 months from the time of rituximab initiation (mean rituximab dose 1,270.4 mg). Ten severe infection events were recorded in 10 (37.0%) patients, corresponding to an event rate of 20.9 per 100 person-years. Pulmonary infections were the leading infectious complications (90%). Eight of the 10 infections occurred during the first 12 months of follow-up. In multivariable analysis, severe infection in the first year was independently associated with age (HR: 1.121, 95% CI: 1.011-1.243, p = 0.031) and serum creatinine level (increased by per 88.4 mu mol/L; HR: 1.493, 95% CI: 1.017-2.191, p = 0.041). Conclusion: In AAV patients receiving ri-tuximab, severe infections were common even with the low-dose regimen. Pulmonary infections were the leading cause, and most infections occurred during the first 12 months of follow-up. Older age and renal dysfunction were the risk factors for infection.

Automated summary

This study evaluated severe infections in AAV patients receiving rituximab in a single Chinese center. Severe infections were common, with pulmonary infections being the leading cause and most infections occurring within the first 12 months of treatment. Older age and renal dysfunction were identified as risk factors for infection.