Flare of a mixed cryoglobulinaemic vasculitis after obinutuzumab infusion
Gregoire Martin de Fremont1, Andrada Chiron2, Roman Krzysiek3
1Rheumatology, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, and Université Paris-Saclay, France.
Objectives:
Obinutuzumab (OBZ) is a new humanised type II anti-CD20 monoclonal antibody (mAb) approved in onco-haematology. Its use as an alternative to rituximab (RTX) in case of immunisation in autoimmune diseases has not been fully assessed yet. Here we report the case of a patient suffering from a refractory cryoglobulinaemic vasculitis (CV) associated to Sjögren's syndrome (SS) and treated with OBZ.
Methods:
Since the patient was immunised against RTX, she was treated with OBZ at relapse. Three days after the infusion of OBZ, she presented a vasculitis flare. Rheumatoid factor level, complement level and cryoprecipitation were evaluated on consecutive serum samples of the patients and after RTX and OBZ addition in vitro.
Results:
No evidence for cross-reactivity between anti-RTX Abs and OBZ was found. However, we could observe in vitro that cryoprecipitation was worsened by the simultaneous presence of anti-RTX Abs and RTX. We suggest that the flare of CV after OBZ infusion could be linked to a large release of immune complexes following B cells lysis induced by OBZ.
Conclusions:
Based on our report, we think that the use of OBZ needs to be carefully discussed in patients with mixed CV.
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