Staphylococcus Aureus carriage and long-term Rituximab treatment for Granulomatosis with polyangiitis
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Abstract
Objective: Chronic nasal carriage of Staphylococcus aureus (SA) increases the risk of relapse while Rituximab (RTX) is an effective agent for inducing and maintaining remission in patients with Granulomatosis with polyangiitis (GPA). We investigated whether B cell depletion and hypogammaglobulinemia that occur during RTX treatment increase the risk of chronic SA nasal carriage and subsequent disease flares, in GPA patients on long-term RTX maintenance therapy. Methods: Retrospective cohort study from a disease registry involving 29 GPA patients receiving RTX maintenance (median RTX dose of 9 g) during a median period of 49 months. Nasal swabs were collected prior and during RTX for a median of 3 and 9 swabs respectively. Persistent SA nasal carriage was defined with the presence of SA in more than 75 % of nasal swabs. Results: SA nasal carriage did not change during RTX (p=0.297). Persistent SA nasal carriage did not increase the risk of relapses (p=0.844) and of severe infections (p=0.144), but reduced the risk of chronic infections (p=0.044). Non-SA carriers were more prone to discontinue RTX due to hypogammaglobulinemia (p=0.122), since they had more profound decline of serum total Ig both after the first 2 g of RTX (p=0.079) and during RTX maintenance (p=0.063). Conclusion: Long-term RTX maintenance therapy in GPA patients did not significantly influence SA nasal carriage status. Persistent SA carriage during long-term RTX treatment did not increase the risk of relapses and was associated with a lower risk of hypogammaglobulinemia associated chronic infections.
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2015. Staphylococcus Aureus carriage and long-term Rituximab treatment for Granulomatosis with polyangiitis. PeerJ PrePrints 3:e972v1 https://doi.org/10.7287/peerj.preprints.972v1note This preprint is not peer-reviewed. You may wish to reference the subsequent peer-reviewed version of this article.
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This is a revised version of a submission to PeerJ for review.
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Competing Interests
W Koldingsnes has received consulting fees, speaking fees and travel grants from Hoffmann-La Roche.
Author Contributions
Emilio Besada conceived and designed the experiments, analyzed the data, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.
Wenche Koldingsnes reviewed drafts of the paper.
Johannes C Nossent wrote the paper, reviewed drafts of the paper.
Human Ethics
The following information was supplied relating to ethical approvals (i.e., approving body and any reference numbers):
All patients gave informed written consent at registry inclusion according to the declaration of Helsinki. The study did not require formal ethical approval in accordance with the standards applied in Norway.
Funding
The authors declare there was no funding for this work.
