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Prolonged IgG recovery following rituximab administration
  1. Christo Tsilifis1,2,
  2. Karen Hartley3,
  3. Nicola Vasey3,
  4. Terry Flood1,
  5. Alexandra Battersby4,
  6. Flora McErlane5,
  7. Eleri Williams1
  1. 1 Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
  2. 2 Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4 Paediatrics, Great North Children's Hospital, Newcastle upon Tyne, UK
  5. 5 Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
  1. Correspondence to Dr Christo Tsilifis, Paediatric Immunology and Infectious Diseases, Level 4 Block 2 Clinical Resources Building, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK; c.tsilifis{at}

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Rituximab (a monoclonal antibody against CD20-expressing B lymphocytes) is increasingly used for antibody-mediated autoimmunity and lymphoproliferative disorders. While safety data for children are limited, recent reports have highlighted neutropenia and persistent hypogammaglobulinaemia1 2 as potential consequences of rituximab therapy. Rarely, rituximab may unveil inborn errors of immunity presenting with autoimmunity.1

We wish to highlight the risk of prolonged time to IgG recovery, particularly among those starting treatment at a younger age, and emphasise the importance of regular monitoring of IgG and IgM levels.

We retrospectively analysed 5 years of rituximab administration at our regional tertiary children’s hospital. Between 2015 and 2020, 180 patients received 583 doses of rituximab. We excluded patients who received rituximab within 6 months of data collection, with inborn errors of immunity, …

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  • Twitter @christotsilifis

  • Contributors CT, KH, NV, AB, FM and EW conceived the work. CT and EW collected data and performed analyses. All authors contributed to the generation and critical review of this manuscript.

  • Funding CT is supported by the Job Research Foundation.

  • Disclaimer The funder had no involvement in the generation of this manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.