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Clin Immunol 2020 Jul 15 [Epub ahead of print]

The potential impact of timing of IVIG administration on safety and efficacy of rituximab administration in the setting of immune tolerance induction for patients with Pompe disease.

Desai AK, Rosenberg AS, Kishnani PS

Abstract

Immunomodulation with rituximab, methotrexate, and intravenous immunoglobulin (IVIG) has shown great success in inducing immune tolerance in a large cohort of enzyme replacement therapy (ERT)-naïve infantile Pompe disease patients. Antibody-dependent cellular cytotoxicity, an important arm of rituximab efficacy, requires B-cell CD20 bound rituximab and the binding of the Fc region of rituximab to Fc receptors on effector cells or to complement. To protect patients against microbial infections when using rituximab, IVIG was added to the immunomodulation regimen used in Pompe disease. Administration of IVIG can saturate neonatal Fc (FcRn) receptors, which recycle administered polyclonal/monoclonal antibodies via the Fc moiety binding to FcRn. As such, the administration of IVIG prior to rituximab may sharply reduce the half-life of rituximab and in turn, its efficacy. Based on this understanding, it is vital to understand the optimal timing of IVIG administration in relation to rituximab administration for the purposes of inducing immune tolerance.


Category: Journal Article
PubMed ID: #32681978 DOI: 10.1016/j.clim.2020.108541
Includes FDA Authors from Scientific Area(s): Drugs
Entry Created: 2020-07-26
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