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Clinical aspects

 

Flare of a mixed cryoglobulinaemic vasculitis after obinutuzumab infusion

1, 2, 3, 4, 5, 6

 

  1. Rheumatology, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, and Université Paris-Saclay, France.
  2. Clinical Immunology Laboratory, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, and UTCBS, CNRS UMR 8258, INSERM U1267, Faculté de Pharmacie de Paris, Université de Paris, France.
  3. Université Paris-Saclay; Clinical Immunology Laboratory, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, and INSERM UMR-996, Clamart, France.
  4. Clinical Immunology Laboratory, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre, and UTCBS, CNRS UMR 8258, INSERM U1267, Faculté de Pharmacie de Paris, Université de Paris, France.
  5. Rheumatology, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre; Université Paris-Saclay, and Centre for Immunology of Viral Infections and Autoimmune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
  6. Rheumatology, AP-HP, Bicêtre Hospital, Le Kremlin Bicêtre; Université Paris-Saclay, and Centre for Immunology of Viral Infections and Autoimmune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Le Kremlin-Bicêtre, France. gaetane.nocturne@aphp.fr

CER14054
2021 Vol.39, N°2 ,Suppl.129
PI 0052, PF 0055
Clinical aspects

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PMID: 33506759 [PubMed]

Received: 18/09/2020
Accepted : 19/10/2020
In Press: 27/01/2021
Published: 19/05/2021

Abstract

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.

DOI: https://doi.org/10.55563/clinexprheumatol/rit83o

Rheumatology Article