Bronchitis During Long-Term Treatment with Rituximab for ANCA-Associated Vasculitis: A Retrospective Cohort Study

Zonozi, Reza; Jeyabalan, Anushya; Efe, Orhan; Sauvage, Gabriel; Cosgrove, Katherine; Laliberte, Karen A.; Niles, John L.

doi:10.22034/rspr.2026.25.1.1431

Bronchitis During Long-Term Treatment with Rituximab for ANCA-Associated Vasculitis: A Retrospective Cohort Study

Document Type : Original Article

Authors

Reza Zonozi ¹^{, 2}

Anushya Jeyabalan ³^{, 4}

Orhan Efe ³^{, 4}

Gabriel Sauvage ³

Katherine Cosgrove ³

Karen A. Laliberte ³

John L. Niles ³

¹ International Kidney Vasculitis and Glomerular Center, Fairfax, VA

² Nephrology Associates of Northern Virginia, Fairfax, VA

³ Vasculitis and Glomerulonephritis Center, Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA

⁴ Harvard Medical School, Boston, Massachusetts, USA

10.22034/rspr.2026.25.1.1431

Abstract

Background: To describe the frequency and risk factors for development of bronchitis in patients receiving prolonged rituximab.
Materials and Methods: We conducted a single-center retrospective cohort study of 113 consecutive adult patients with ANCA-associated vasculitis (AAV) who had continuous B cell depletion with rituximab for greater than 24 months. The primary outcome was an episode of cough measured with an ordinal scale as follows: 0=no cough; 1=daily cough, non-productive; 2=cough with sputum production once daily; 3 = cough with sputum production twice or more daily. Secondary outcome measures included serum immunoglobulin G (IgG) level, sputum culture, and antibiotic use. Logistic regression analysis was used to assess the odds ratio of developing cough.
Results: The median (IQR) follow-up was 3.4 years (IQR, 2.7–5.2). A non-productive cough was identified in 4.4% of patients (n=5). A daily cough with sputum production once daily was identified in 6.2% of patients (n=7), and a daily cough with sputum production twice or more daily was identified in 11.5% of patients (n=13). 44% of sputum cultures were positive for a pathogenic organism. The most common were Haemophilus influenzae and Aspergillus fumigatus. Antibiotics were used in 19.5% of patients (n=22). The median (IQR) nadir IgG level was 675 mg/dL (521–798). No patient received intravenous IgG supplementation. No associations were found to predict cough.
Conclusion: Bronchitis was seen in approximately one-fifth of patients with AAV on prolonged B cell depletion with rituximab.

Keywords

ANCA-associated vasculitis

Rituximab

Bronchitis

Adverse events

Subjects