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| Item Type: | Article |
|---|---|
| Title: | Age, low immunoglobulin G, and M serum levels predict infections in people with AQP4-IgG+ NMOSD treated with rituximab-A multicenter cohort study from the German Neuromyelitis Optica Study Group (NEMOS) |
| Creators: |
Engels, Daniel  ORCID: https://orcid.org/0000-0002-9877-6987, Herfurth, Mariella, Havla, Joachim, Schindler, Patrick, Ruprecht, Klemens, Schwake, Carolin, Ringelstein, Marius, Fischer, Katinka, Schubert, Charlotte ORCID: https://orcid.org/0000-0002-2967-4290, Schiffmann, Insa ORCID: https://orcid.org/0000-0001-8315-5398, Hümmert, Martin W, Giglhuber, Katrin, Jarius, Sven, Vardakas, Ioannis ORCID: https://orcid.org/0009-0005-5443-1142, Grothe, Matthias, Etgen, Thorleif, Warnke, Clemens ORCID: https://orcid.org/0000-0002-3510-9255, Naumann, Jasmin, Hoffmann, Frank, Senel, Makbule, Wildemann, Brigitte, Berthele, Achim, Trebst, Corinna, Häußler, Vivien, Aktas, Orhan, Ayzenberg, Ilya, Bellmann-Strobl, Judith ORCID: https://orcid.org/0000-0003-2615-1643, Bergh, Florian Then and Kümpfel, Tania ORCID: https://orcid.org/0000-0001-7509-5268
|
| Abstract: | INTRODUCTION: Rituximab is effective and widely used as long-term treatment in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD). However, infections remain a significant concern during rituximab treatment. METHODS: We conducted a retrospective multicenter cohort study within the NMO Study Group (NEMOS) in Germany, analyzing demographic and clinical data from people with AQP4-IgG+ NMOSD receiving rituximab or azathioprine by retrospective chart, and compared infection occurrence and severity. For rituximab-treated patients, we collected laboratory data (blood lymphocytes, B-cell counts, serum IgG, IgM, and IgA levels), assessed risk factors for infections, and determined the probability of infection within a 3-month window before and after the laboratory assessment. RESULTS: In 92/170 rituximab and in 12/33 azathioprine treatment episodes, one or more infections were documented. Rituximab and azathioprine showed comparable types and risk of infection (HR = 1.24, 95% CI: 0.68-2.25). Rituximab-treated individuals older than 60 years had a higher risk of infection (HR = 1.62, 95% CI: 1.02-2.57). Hypogammaglobulinemia (IgG < 6.0 g/L: OR = 2.27, 95% CI: 1.15-4.48; IgM < 0.3 g/L: OR = 2.08, 95% CI: 1.05-4.09) predicted infections and the occurrence of both low IgG and IgM serum levels further increased the risk of infection (OR = 2.77, 95% CI: 1.10-6.98) during rituximab treatment. Low IgG and IgA serum levels as well as lymphopenia predicted infection-related hospitalizations. CONCLUSION: Age > 60 years and immunoglobulin serum levels during rituximab treatment may serve as predictors for infection and help to individualize treatment decisions in NMOSD. |
| Keywords: | AQP4-IgG, Hypogammaglobulinemia, Infections, NMOSD, Rituximab |
| Source: | European Journal of Neurology |
| ISSN: | 1351-5101 |
| Publisher: | Wiley |
| Volume: | 33 |
| Number: | 2 |
| Page Range: | e70520 |
| Date: | February 2026 |
| Official Publication: | https://doi.org/10.1111/ene.70520 |
| PubMed: | View item in PubMed |
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