Evidence map›Paper›PMID 41637530›Full record

ArticleEuropean journal of neurology2026

Age, Low Immunoglobulin G, and M Serum Levels Predict Infections in People With AQP4-IgG+ NMOSD Treated With Rituximab-A Multicenter Cohort Study From the German Neuromyelitis Optica Study Group (NEMOS).

Daniel Engels, Mariella Herfurth, Joachim Havla, Patrick Schindler, Klemens Ruprecht, Carolin Schwake, Marius Ringelstein, Katinka Fischer, Charlotte Schubert, Insa Schiffmann and 20 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

30 authors.

Daniel EngelsInstitute of Clinical Neuroimmunology and Biomedical Center (BMC), LMU University Hospital, Faculty of Medicine, LMU Munich, Munich, Germany.ORCID https://orcid.org/0000-0002-9877-6987
Mariella HerfurthDepartment of Neurology, University of Leipzig, Leipzig, Germany.
Joachim HavlaInstitute of Clinical Neuroimmunology and Biomedical Center (BMC), LMU University Hospital, Faculty of Medicine, LMU Munich, Munich, Germany.
Patrick SchindlerDepartment of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Klemens RuprechtDepartment of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Carolin SchwakeDepartment of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany.
Marius RingelsteinDepartment of Neurology, Centre for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University, Düsseldorf, Germany.
Katinka FischerDepartment of Neurology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany.
Charlotte SchubertDepartment of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID https://orcid.org/0000-0002-2967-4290
Insa SchiffmannDepartment of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID https://orcid.org/0000-0001-8315-5398
Martin W HümmertDepartment of Neurology, Hannover Medical School, Hannover, Germany.
Katrin GiglhuberDepartment of Neurology, School of Medicine and Health, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
Sven JariusMolecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Ioannis VardakasDepartment of Neurology, University of Ulm, Ulm, Germany.ORCID https://orcid.org/0009-0005-5443-1142
Matthias GrotheDepartment of Neurology, University of Greifswald, Greifswald, Germany.
Thorleif EtgenDepartment of Neurology, Kliniken Südostbayern-Klinikum, Traunstein, Germany.
Clemens WarnkeDepartment of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.ORCID https://orcid.org/0000-0002-3510-9255
Jasmin NaumannDepartment of Neurology, Knappschaftsklinikum Sulzbach, Sulzbach, Germany.
Frank HoffmannDepartment of Neurology, Martha-Maria Hospital Halle-Dölau, Halle, Germany.
Makbule SenelDepartment of Neurology, University of Ulm, Ulm, Germany.
Brigitte WildemannMolecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Achim BertheleDepartment of Neurology, School of Medicine and Health, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
Corinna TrebstDepartment of Neurology, Hannover Medical School, Hannover, Germany.
Vivien HäußlerDepartment of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Orhan AktasDepartment of Neurology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany.
Ilya AyzenbergDepartment of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany.
Judith Bellmann-StroblExperimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany.
Florian Then BerghDepartment of Neurology, University of Leipzig, Leipzig, Germany.
Tania KümpfelInstitute of Clinical Neuroimmunology and Biomedical Center (BMC), LMU University Hospital, Faculty of Medicine, LMU Munich, Munich, Germany.ORCID https://orcid.org/0000-0001-7509-5268
Neuromyelitis Optica Study Group (NEMOS)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionRituximab is effective and widely used as long-term treatment in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD). However, infections remain a significant concern during rituximab treatment.

methodsWe conducted a retrospective multicenter cohort study within the NMO Study Group (NEMOS) in Germany, analyzing demographic and clinical data from people with AQP4-IgG+ NMOSD receiving rituximab or azathioprine by retrospective chart, and compared infection occurrence and severity. For rituximab-treated patients, we collected laboratory data (blood lymphocytes, B-cell counts, serum IgG, IgM, and IgA levels), assessed risk factors for infections, and determined the probability of infection within a 3-month window before and after the laboratory assessment.

resultsIn 92/170 rituximab and in 12/33 azathioprine treatment episodes, one or more infections were documented. Rituximab and azathioprine showed comparable types and risk of infection (HR = 1.24, 95% CI: 0.68-2.25). Rituximab-treated individuals older than 60 years had a higher risk of infection (HR = 1.62, 95% CI: 1.02-2.57). Hypogammaglobulinemia (IgG < 6.0 g/L: OR = 2.27, 95% CI: 1.15-4.48; IgM < 0.3 g/L: OR = 2.08, 95% CI: 1.05-4.09) predicted infections and the occurrence of both low IgG and IgM serum levels further increased the risk of infection (OR = 2.77, 95% CI: 1.10-6.98) during rituximab treatment. Low IgG and IgA serum levels as well as lymphopenia predicted infection-related hospitalizations.

conclusionAge > 60 years and immunoglobulin serum levels during rituximab treatment may serve as predictors for infection and help to individualize treatment decisions in NMOSD.

Indexed as

Aquaporin 4Immunoglobulin GImmunoglobulin MImmunologic FactorsInfectionsNeuromyelitis OpticaRituximabAdultAgedAge FactorsAutoantibodiesAzathioprineCohort StudiesFemaleGermanyHumansAQP4 protein, humanAquaporin 4AutoantibodiesAzathioprineImmunoglobulin GImmunoglobulin MImmunologic FactorsRituximabAQP4‐IgGhypogammaglobulinemiainfectionsNMOSDrituximab

Identifiers

PMID41637530
PMCPMC12871897

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.