Accelerated infusion rates of rituximab are well tolerated and safe in rheumatology practice: a single-centre experience

Abstract

Due to the possible risk of infusion reactions of rituximab (RTX), a slow infusion rate (total infusion time, 255 min) is suggested for rheumatological use. However, especially in oncology field, accelerated infusion of RTX is reported to be well tolerated and safe. The aim of our study was to evaluate whether accelerated infusion rates of RTX would similarly be safe and tolerable in rheumatoid arthritis (RA) patients and other off-label rheumatological indications. All patients treated with RTX for RA and other autoimmune diseases between May 2011 and January 2012 were recruited to the study. Each treatment course consisted of two RTX 1,000 mg infusions, 2 weeks apart. Total time of the infusion for the first cycle was 255 min. Second and subsequent infusions were administered over 120 min as follows: 0-30 min, 100 mg; 30-60 min, 200 mg; 60-90 min, 300 mg; and 90-120 min, 400 mg. The Clinical Trials Classification of Adverse Events (CTCAE) version 4.3 was used to categorise side effects. The study population comprised 68 patients [F/M, 59:9; mean age, 52.4 (10.6) years]: 60 with RA, 4 with systemic lupus erythematosus (SLE), 1 with non-Hodgkin's lymphoma with SLE and 3 with vasculitis. A total of 77 fast infusions were administered. Eleven patients (16.2 %) had taken a fast infusion at the first course. A total of nine patients experienced at least one AE. Seven patients had a reaction on the first infusion (infusion-related reaction (IRR)), two patients on the second infusion and one patient on both infusions. When graded from 1 to 5 according to CTCAE v. 4.3, grade 1 IRRs were observed in a total of seven patients and grade 2 IRR in three patients. In this study of fast infusions, adverse events after RTX were mostly mild and seem to be well tolerated. Faster rituximab infusion times seem to be safe and might be incorporated into routine practice.

A Retrospective Study on Infusion-Related Reactions to Rituximab in a Heterogeneous Pediatric Population

“…13 Numerous studies in adult populations have recently assessed the safety of a "rapid-infusion" of rituximab over 90 minutes both in oncology practice and in treating autoimmune diseases. 2,[14][15][16] Considering the lack of literature on IRR in pediatric populations, we assessed the risk and severity of IRR in a pediatric population. To our knowledge, this is the first study assessing IRRs in a large set of diseases treated with rituximab in a heterogeneous pediatric population.…”

Presence of anti-rituximab antibodies predicts infusion-related reactions in patients with systemic lupus erythematosus

“…IRR were classified in accordance with Common Terminology Criteria for Adverse Events v4 criteria (online supplementary table 1). 5 Presence of ADA was assessed via a bridging electrochemiluminescence assay using biotinylated and ruthenylated RTX as capture and detection. Χ 2 with Bonferroni correction was used to compare categorical differences between ADA + and ADA - groups.…”

Use of a Pharmacy Protocol to Convert Standard Rituximab Infusions to Rapid Infusion Shortens Outpatient Infusion Clinic Visits

“…However, rates of infusion reactions may be higher in patients with rheumatoid arthritis compared with patients with cancer. 9,14,15 As more data on rapid infusion in rheumatoid arthritis become available, hospitals may want to consider that population for rapid infusion eligibility.…”