---
title: "Infections and Hypogammaglobulinemia with Low‑Dose Rituximab in Myasthenia Gravis — Full Text Not"
id: "frontiers-in-immunology-18-infections-and-hypogammaglobulinemia-in-myasthenia-gravis-patients-receiving"
canonical_url: "https://medichelpline.com/clinical-feed/frontiers-in-immunology-18-infections-and-hypogammaglobulinemia-in-myasthenia-gravis-patients-receiving"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "Frontiers in Immunology"
source_url: "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1907574"
published_at: "2026-08-28T00:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Infections and Hypogammaglobulinemia with Low‑Dose Rituximab in Myasthenia Gravis — Full Text Not
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/frontiers-in-immunology-18-infections-and-hypogammaglobulinemia-in-myasthenia-gravis-patients-receiving
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** Frontiers in Immunology
- **Source URL:** [Original Journal Publication](https://www.frontiersin.org/articles/10.3389/fimmu.2026.1907574)
- **Published At:** 2026-08-28T00:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The linked Frontiers in Immunology page and provided source content do not contain the study text, methods, results, or conclusions for the article titled about **myasthenia gravis**, low‑dose **rituximab**, **infections**, and **hypogammaglobulinemia**. - The source material available in the prompt is site navigation and section listings from the journal; no study data, patient characteristics, dosing regimens, follow‑up duration, infection incidence, or immunoglobulin measurements were reported there. - Because the article body was not included, specific outcomes (rates of infections, severity, association with hypogammaglobulinemia, or risk factors) are not available from the supplied source and cannot be restated or summarized. - The absence of article details means key elements normally expected in a cohort study (study design, inclusion/exclusion criteria, statistical analyses, safety monitoring, ethical approvals) were not reported in the provided content. - Readers seeking study specifics — including sample size, definitions of hypogammaglobulinemia, infection classifications, timing relative to **rituximab** doses, and any management recommendations — must consult the full published article or journal site for the complete text. - This summary preserves the original study topic and highlights the unavailability of primary data in the supplied source; no clinical conclusions or numeric findings are asserted because they were not present in the source material.
## Clinical Analysis & Structured Key Points
Frontiers | Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study ORIGINAL RESEARCH article Front. Immunol. , 28 August 2026 Sec. B Cell Biology Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1907574 Published in Frontiers in Immunology B Cell Biology 7 impact factor 11.3 citescore Part of a Research Topic Immunological mechanisms and therapeutic innovations in Myasthenia Gravis: from pathogenesis to precision medicine Submission open 3025 views 7 articles Editor & Reviewers Edited by H H Hao Hu Reviewed by F O Fitri Octaviana T C TOMMASO CARAVITA DI TORITTO Outline Figures and Tables Figure 1 View in article Figure 2 View in article Figure 3 View in article Figure 4 View in article Table 1 Baseline characteristics of patients. View in article Table 2 Infectious events in MG patients receiving RTX. View in article Table 3 The distribution of HGG in MG patients receiving RTX. View in article Table 4 Multivariate cox regression analysis of the first infection. View in article Table 5 Multivariate cox regression analysis of the first Severe Lower Respiratory Tract Infection. View in article Table 6 Multivariate cox regression analysis of HGG. View in article ORIGINAL RESEARCH article Front. Immunol. , 28 August 2026 Sec. B Cell Biology Volume 17 - 2026 | https://doi.org/10.3389/fimmu.2026.1907574 Infections and hypogammaglobulinemia in myasthenia gravis patients receiving low-dose rituximab: a real-world cohort study R G Rongjing Guo † Y Z Yifan Zhang † T G Ting Gao † Z R Zhe Ruan C S Chao Sun S H Sijia Hao Y T Yonglan Tang Q W Qingqing Wang X H Xiaoxi Huang X C Xiangqi Cao Z L Zhuyi Li D L Danni Liu Y L Yu Liu +5 more T C Ting Chang * Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China Article metrics View details Abstract Aims: We investigated the incidence of infections and hypogammaglobulinemia (HGG) in patients with myasthenia gravis (MG) receiving long-term low-dose rituximab (RTX) maintenance therapy and identified related risk factors. Methods: This single-center retrospective cohort study enrolled MG patients treated with low-dose RTX maintenance. Cox proportional hazards regression was performed to analyze risk factors for infections and HGG. Results: A total of 186 patients were included. The median age at RTX initiation was 52.50 years, and the median follow-up was 2.41 years. Infections occurred in 29 patients (15.59%), with a median time to first infection of 170.37 days, mostly during the first cycle. The 1- and 2-year infection rates were 13.41 (95% confidence interval [CI], 8.47–20.28) and 9.20 (95% CI, 6.06–13.36) per 100 person-years. Severe infections developed in 21 patients (11.29%). The most prevalent infection was lower respiratory tract infection (LRTI), with 19 episodes (61.29%). HGG was present in 51 patients (27.42%). HGG was an independent risk factor for infection (HR = 5.53, P 0.05). Collinearity among covariates was assessed using the variance inflation factor (VIF). All included variables had VIF values less than 3, indicating no obvious multicollinearity. Incident HGG occurring during follow-up was incorporated as a time-dependent covariate in primary regression models. To mitigate overfitting given the limited number of outcome events, parsimonious multivariate models were built by retaining predictors exhibiting P < 0.10 in univariate Cox regression alongside clinically critical confounders. All regression outputs were expressed as hazard ratios (HR) with corresponding 95% confidence intervals (CIs). Notably, the HR for prednisone reflected the relative risk increment associated with each 5 mg daily increase in equivalent prednisone dose. One- and two-year infection incidence rates per 100 person-years were computed as (number of infectious events/total cumulative person-years) ×100. Poisson approximation was applied to calculate the 95% CIs for these incidence rates. All statistical tests were two-sided, and a threshold of P < 0.05 was designated to denote statistical significance. Results Patient characteristics A total of 186 patients were included in the final analysis. The median age at initiation of RTX therapy was 52.50 years (IQR: 37.00–64.00), and 104 patients (55.91%) were female. The median disease duration was 24.50 months (IQR: 9.00–63.00). Anti-AChR and MuSK antibodies were positive in 135 (72.58%) and 28 (15.05%) patients, respectively. Comorbidities included diabetes mellitus (n=26, 13.98%), hypertension (n=50, 26.88%), cardiovascular/cerebrovascular disease (n=7, 3.76%), thyroid disorders (n=7, 3.76%), and other autoimmune diseases (n=5, 2.69%). In addition, 71 patients (38.17%) presented with isolated bulbar involvement, 15 (8.06%) with isolated respiratory involvement, and 47 (25.27%) with combined bulbar and respiratory involvement. The total follow-up time was 479.24 person-years, with a median follow-up duration of 2.41 years (IQR: 1.05–3.87). The median number of RTX treatment cycles per patient was 3.00 (range: 1.00–9.00). Among all patients, 185 individuals (99.46%) received at least one concomitant medication. Among these individuals, including pyridostigmine (n = 178, 95.70%), prednisone (n = 158, 84.95%), and non-steroidal immunosuppressants (n = 56, 30.11%). The most commonly used non-steroidal immunosuppressant was tacrolimus (n = 38, 20.43%), followed by azathioprine (n = 10, 5.38%) and mycophenolate mofetil (n = 7, 3.76%). The baseline characteristics of the study population are summarized in Table 1 . The baseline characteristics of 29 patients excluded are summarized in Supplementary Table 1 . Table 1 Variables Total (n = 186) Demographic characteristics Age, Y, Median (IQR) 52.50 (37.00, 64.00) Female, n(%) 104/186 (55.91) Smoking history 29/186 (15.59) Alcohol history 13/186 (7.00) MG disease characteristics Disease duration, Months, Median (IQR) 24.50 (9.00, 63.00) Antibody type, n(%) AChR 135 (72.58) MuSK 28 (15.05) Other 4 (2.15) Seronegative 19 (10.22) MGFA stage, n(%) I 35 (18.82) IIA 41 (22.04) IIB 52 (27.96) IIIA 16 (8.60) IIIB 30 (16.13) IVA 3 (1.61) IVB 9 (4.84) MG-ADL, Median (IQR) 5.50 (3.00, 8.00) QMG, Median (IQR) 12.00 (7.25, 17.00) Comorbidities Diabetes, n(%) 26/186 (13.98) Hypertension, n(%) 50/186 (26.88) CV/CVD, n(%) 7/186 (3.76) Thyroid disease, n(%) 7/186 (3.76) Other autoimmune diseases, n(%) 5/186 (2.69) Bulbar/Respiratory involvement, n(%) Bulbar only 71/186 (38.17) Respiratory only 15/186 (8.06) Bulbar + Respiratory 47/186 (25.27) B cell counts CD19+/CD27+B, Median (IQR) 2.91 (1.98, 5.26) CD19+B, Median (IQR) 10.59 (7.25, 15.33) CD20+B, Median (IQR) 10.32 (7.00, 15.21) RTX treatment cycles, Median (Range) 3.00 (1.00 - 9.00) Follow-up time, Years, Median (IQR) 2.41 (1.05, 3.87) Concomitant medications, n(%) 185/186 (99.46) Pyridostigmine, n(%) 178/186 (95.70) Pyridostigmine daily dose, mg, Median (IQR) 210.00 (180.00, 352.50) Prednisone, n(%) 158/186 (84.95) Prednisone daily dose, mg, Median (IQR) 20.00 (20.00, 30.00) Non-steroidal immunosuppressant, n(%) 56/186 (30.11) Type of non-steroidal immunosuppressant, n(%) Efgartigimod 1 (0.54) Azathioprine 10 (5.38) Mycophenolate mofetil 7 (3.76) Tacrolimus 38 (20.43) Baseline characteristics of patients. IQR, interquartile range; AChR, acetylcholine receptor; MuSK, muscle-specific receptor tyrosine kinase; MGFA, Myasthenia Gravis Foundation of America Clinical Classification; MG-ADL, Myasthenia Gravis Activities of Daily Living; QMG, Quantitative Myasthenia Gravis; CV/CVD, cardiovascular/cerebrovascular disease; RTX, rituximab; Range, observed range. Incidence of infections and HGG after RTX therapy After RTX therapy was initiated, 29 patients (15.59%) experienced 31 infectious episodes, of which 21 patients (11.29%) developed 23 severe infections (≥Grade 3) ( Table 2 ). The median time to the first infection was 170.37 days (IQR: 65.60–342.63), and the median RTX treatment cycle at the time of infection was 1 (range: 1–6 cycles). Figure 2 depicts the Kaplan-Meier curve for time to first infection following RTX initiation. The number of patients at risk at each time point was 186 at month 0, 175 at month 3, 167 at month 6, 153 at month 9, 142 at month 12, 136 at month 15, 135 at month 18, 126 at month 21, and 108 at month 24. Among all types of infections, lower respiratory tract infections (LRTIs) (N = 19) were the most frequent, accounting for 61.29% of all episodes ( Table 2 ). The 1- and 2-year infection incidence rates were 13.41 (95% CI, 8.47-20.28) and 9.20 (95% CI, 6.06-13.36) per 100 person-years, respectively. Table 2 Type of infection No. of episodes (%) Skin infection 2 (6.45) Upper respiratory tract infection 5 (16.13) Gastrointestinal infection 3 (9.68) Lower respiratory tract infection 19 (61.29) Urinary tract infection 1 (3.23) Central nervous system infection 1 (3.23) Total 31 Infectious events in MG patients receiving RTX. Figure 2 Time to first infection in patients after the initiation of RTX treatment. Severe LRTIs occurred in 18 patients (9.68%). Among the 29 patients who developed infections, the causative pathogen was identified in 17 patients (58.62%). Multiple pathogens could be detected in a single patient. The pathogens included 9 episodes of bacteria, 8 episodes of fungi, and 6 episodes of viruses. Notably, Pneumocystis jirovecii pneumonia was diagnosed in 7 of the 21 patients with severe infections (33.33%). Information on all infectious episodes is provided in Supplementary Table 2 . Regarding outcomes, 25 of the 29 infected patients (86.21%) showed clinical improvement, 3 patients (10.34%) died (2 due to myasthenic crisis and 1 due to pulmonary infection), and 1 patient (3.45%) had an unknown outcome. During the follow-up period, HGG was detected in 51 patients (27.42%), with a median time to HGG onset of 218.36 days (IQR: 82.02–400.48). In the overall study population, low IgG levels were recorded in 18 patients (9.68%), low IgM levels were recorded in 37 patients (19.89%), and low IgA levels were recorded in six patients (3.23%). Among patients with low IgG levels, nine patients (50.00%) had mild HGG, whereas four (22.22%) and five patients (27.78%) had moderate and severe HGG, respectively. Additionally, among patients who developed HGG, eight patients (15.69%) showed reductions in two immunoglobulin classes, and one patient (1.96%) showed reductions across all three immunoglobulin classes ( Table 3 ). Among 15 patients who developed infection following HGG diagnosis, the median interval from HGG diagnosis to subsequent infection was 65.00 days (IQR: 1.00–195.50). The cumulative incidence of HGG in MG patients receiving RTX is sh
## Related Clinical Research

- [Liver–kidney crosstalk in primary biliary cholangitis: article summary and missing details](https://medichelpline.com/clinical-feed/frontiers-in-immunology-15-liver-kidney-crosstalk-in-primary-biliary-cholangitis-insights-into-the.md)
- [Peripheral neuropathy in ANCA-associated vasculitis: clinical and electrodiagnostic context when a](https://medichelpline.com/clinical-feed/frontiers-in-immunology-17-clinical-and-electrodiagnostic-features-of-nerve-conduction-study-classified.md)
- [Disseminated Acanthamoeba Infection With Necrotic Skin Lesions And Granulomatous Vasculitis](https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-13-disseminated-acanthamoeba-infection-with-necrotic-skin-lesions-and-granulomatous-vasculitis-united-states.md)
- [Nicotine metabolism rate and myocardial infarction risk in people with HIV who smoke](https://medichelpline.com/clinical-feed/plos-one-12-rate-of-nicotine-metabolism-on-risk-of-myocardial-infarction-among-people-with.md)
- [Determinants of Favorable MDR-TB Treatment Outcomes in Zambia, 2018–2022](https://medichelpline.com/clinical-feed/plos-one-16-determinants-of-favorable-treatment-outcomes-in-multidrug-resistant.md)

## Navigation
- [← Back to Infectious Disease Feed](https://medichelpline.com/clinical-feed/infectious-disease.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.