Rituximab-induced hypogammaglobulinemia in childhood nephrotic syndrome: a systematic review and meta-analysis.
Rituximab nearly doubles the risk of hypogammaglobulinemia in nephrotic syndrome children
Rituximab-induced hypogammaglobulinemia in childhood nephrotic syndrome: a systematic review and meta-analysis.
UNLABELLED: Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome (e.g., steroid-dependent or frequently relapsing disease).
We conducted a systematic review to estimate the incidence proportion of hypogammaglobulinemia after rituximab and the frequency of concomitant infections in children with nephrotic syndrome.
rituximab raises the risk of low antibody levels
The pooled incidence of hypogammaglobulinemia in children with nephrotic syndrome receiving rituximab was 11.4% (95% CI, 6.4, 19.5).
In 517 episodes of hypogammaglobulinemia, 93 (18%) infections occurred, four of which were fatal.
WHAT IS KNOWN: • Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome. • Post-rituximab hypogammaglobulinemia is a recognized adverse effect that may predispose to severe, including fatal, infections; however, the magnitude of risk of poorly understood in pediatric population.
Hypogammaglobulinemia is a common side effect of rituximab that can result in life-threatening infections.
The risk of hypogammaglobulinemia and infections should be weighed against the effectiveness of rituximab for nephrotic syndrome management. Prospero registration: CRD42024536465.
WHAT IS KNOWN: • Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome.