ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 113

Evaluation of B-cell Depletion with Rituximab and IVIG Concurrent Treatment in Pediatric Autoimmune Brain Disease

Alexis Wilsey1, Heather Van Mater 2 and Laura Cannon 2, 1Durham, 2Duke University, Durham

Meeting: 2020 Pediatric Rheumatology Symposium

Keywords: Intravenous immunoglobulin (IVIG), Rituximab

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.

Date: Saturday, May 2, 2020

Title: Poster Session 3

Session Type: ACR Abstract Session

Session Time: 4:15PM-5:15PM

Background/Purpose: Rituximab is standard therapy in treating autoimmune brain disease (ABD) including refractory autoimmune encephalitis (AE) and Neuromyelitis Optica Spectrum Disease (NMOSD). Recommendations for continuing concurrent IVIG during rituximab treatment in patients with ABD vary. Mechanisms of rituximab B cell depletion include antibody-dependent cell-mediated cytotoxicity and complement mediated cytotoxicity. In contrast, IVIG’s immunomodulation includes the attenuation of complement-mediated cytotoxicity, blockade of the FC receptors in the reticuloendothelial system, and modulation of NK cells. Despite the frequent use of IVIG as adjunct therapy, there is little data on how concomitant use may affect B-cell depletion and efficacy.

The objective of this study was to determine if concurrent treatment of rituximab with IVIG altered B-cell depletion and time to repopulation in pediatric patients with ABD. We also assessed rates of hypogammaglobinemia and significant infections.

Methods: We conducted a retrospective chart review of 58 patients who received Rituximab for treatment of ABD. There are currently no accepted criteria for a diagnosis of autoimmune encephalitis; however, all patients in this study were determined to meet criteria for probable autoimmune encephalitis by a multidisciplinary team including a pediatric neurologist, rheumatologist and psychiatrist. All patients diagnosed with NMOSD in this study met established criteria. 50 patients met our inclusion criteria of being followed for >1year in our clinic, receiving standard rituximab induction, and having CD19 or CD20 counts recorded following treatment.  

We calculated time from the most recent rituximab dosing to repopulation, and noted if IVIG was given within 4 weeks of rituximab dosing. Lymphocyte repopulation was defined as a percentage of CD19 or CD20 cells >0.1. We recorded patients with hypogammaglobinemia and those with significant infections requiring prolonged antibiotic courses or hospitalization.

Results: 158 doses of rituximab were given, with 125 given concurrently with IVIG and 33 without. There was no statistical difference in B-cell repopulation in those receiving concurrent treatment, 81 doses(64.8%), compared to rituximab alone, 19 (57.6%). Similarly, there was no statistical difference in mean time to repopulation, with 182.6 days for concomitant treatment and 185.1 days for rituximab alone. Unlike a recent report of high rates of immunodeficiency in autoimmune brain disease, we found hypogammaglobinemia occurred in only 8 of our patients (16% of study population). Within this subset, all were treated for infection related to hypogammaglobinemia except for one, who had persistent low levels without infections. All patients with infection related complications had prompt recovery with replacement dose IVIG and antibiotics. Hypogammaglobinemia was noted on average 12.9 months after last rituximab dose and 18.5 months after last IVIG dose.

Conclusion: There was no difference in rates or time to B cell repletion in patients treated with rituximab alone vs concurrent IVIG treatment. Rates of hypogammaglobinemia were lower in our cohort than recent reports.


Disclosure: A. Wilsey, None; H. Van Mater, None; L. Cannon, None.

To cite this abstract in AMA style:

Wilsey A, Van Mater H, Cannon L. Evaluation of B-cell Depletion with Rituximab and IVIG Concurrent Treatment in Pediatric Autoimmune Brain Disease [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/evaluation-of-b-cell-depletion-with-rituximab-and-ivig-concurrent-treatment-in-pediatric-autoimmune-brain-disease/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2020 Pediatric Rheumatology Symposium

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-b-cell-depletion-with-rituximab-and-ivig-concurrent-treatment-in-pediatric-autoimmune-brain-disease/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology