Secondary hypogammaglobulinemia in patients with multiple sclerosis on anti-CD20 therapy: pathogenesis, risk of infection, and disease management

Hypogammaglobulinemia is characterized by reduced serum immunoglobulin levels. Secondary hypogammaglobulinemia of considerable interest to the practicing physician because it a potential complication some medications and may predispose patients serious infections. Patients with multiple sclerosis (MS) treated B-cell–depleting anti-CD20 therapies are particularly at risk developing hypogammaglobulinemia. Among these patients, has been associated an increased The mechanism which arises (ocrelizumab, ofatumumab, ublituximab, rituximab) remains unclear does not appear be simply due reduction in circulating B-cell Further, despite association between therapies, hypogammaglobulinemia, infections, there currently no generally accepted monitoring treatment approach among clinicians treating MS. Here, we review literature discuss possible mechanisms secondary MS, results MS therapy clinical trials, infection for strategies disease management. We also include suggested best-practice specifically address therapies.