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Rituximab Hypogammaglobulinaemia — SCE Rheumatology MCQ

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HardVasculitisRituximab HypogammaglobulinaemiaSCE Rheumatology

A 60-year-old man with ANCA vasculitis on Rituximab maintenance develops hypogammaglobulinaemia (IgG 2.8 g/L). He has recurrent sinopulmonary infections. What is the recommended management?

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Correct answer: B — Check immunoglobulin levels before each Rituximab cycle; for symptomatic hypogammaglobulinaemia with recurrent infections immunoglobulin replacement therapy and consideration of Rituximab dose reduction or discontinuation

Rituximab-induced hypogammaglobulinaemia is an increasingly recognised complication of long-term B-cell depletion therapy. BSR 2025 AAV guidelines recommend monitoring immunoglobulin levels before each Rituximab cycle. IgG levels <4 g/L with recurrent infections warrant consideration of: subcutaneous immunoglobulin replacement therapy antibiotic prophylaxis and modification of the Rituximab maintenance regimen (extended intervals reduced dose or discontinuation). Risk factors include cumulative Rituximab exposure prior immunosuppressive therapy and older age. The decision to continue or stop Rituximab should balance the infection risk of hypogammaglobulinaemia against the relapse risk of stopping vasculitis maintenance.

Reference: BSR 2025 AAV guidelines; Roberts DM et al 2015 hypogammaglobulinaemia on Rituximab