[Infectious events during the course of autoimmune diseases treated with rituximab: A retrospective study of 93 cases]

Abstract

Objective: Describe the occurring infections in patients treated with rituximab for an autoimmune disease.

Methods: Retrospective and monocentric study of 93 adult patients treated with rituximab for autoimmune indications over a nine years period.

Results: Thirty-eight patients suffered from a total of 95 infections. Out of them, 18 patients (19 %) had had at least an infectious episode triggering a hospital admission and/or intravenous treatment. The infections occurred mainly during the first year of the treatment (65 %) and if the courses are repeated (P=0.04). They were mainly pulmonary infections. Severe infections, recorded in 79 % of the cases, were mostly of bacterial origin (43 %) and viral (23 %). Two cases of pneumocystis pneumonia and one case of invasive pulmonary aspergillosis were also recorded. The notion of vaccination was present in less than half of the cases, and 39 % of the patients were already receiving a prophylactic treatment against pneumocystis pneumonia. Patients over the age of 65 years (40 %) had developed less infections (P<0.05). Eight of the initial 93 patients died, half of them because of infectious complications.

Conclusion: Infectious complications are frequent, become early and are potentially severe. Imputability to rituximab is not certain. However, this could lead to better codify rituximab prescriptions and take adapted and associated measures in order to facilitate infection prevention and, if an infection does occur, to treat it at the earliest stage possible. The age doesn't seem to be a risk factor.

Keywords: Autoimmune diseases; Elderly patients; Infections; Maladies auto-immunes; Patients âgés; Prophylaxie; Prophylaxis; Rituximab.