Antimicrobial prophylaxis in patients with immune thrombocytopenia treated with rituximab: a retrospective multicenter analysis

Raso, Simona; Napolitano, Mariasanta; Arrigo, Giulia; Reale, F.; Lucchesi, Alessandro; Silimbani, Paolo; Maggio, Aurelio; Calvaruso, Giuseppe; Consoli, Ugo; Mannina, Donato; Giordano, Giulio; Santoro, Marco; Accurso, Vincenzo; Siragusa, Sergio

doi:10.1007/s00277-021-04438-7

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…46 Some clinicians use anti-infective prophylaxis for patients undergoing rituximab treatment, though evidence to support its use is lacking. 55 Given the ongoing COVID-19 pandemic, clinicians also must take into consideration the B-cell depletion effect of rituximab, which may impair vaccine response for at least 6 months after administration. 56…”

Section: Rituximabmentioning

confidence: 99%

Management of Adult Patients with Immune Thrombocytopenia (ITP): A Review on Current Guidance and Experience from Clinical Practice

Song¹,

Al‐Samkari²

2021

JBM

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Immune thrombocytopenia (ITP) is an autoimmune process resulting in increased destruction and inadequate production of platelets that can result in bleeding, fatigue, and reduced health-related quality of life. While treatment is not required for many patients with ITP, the occurrence of bleeding manifestations, severe thrombocytopenia, and requirement for invasive procedures are among the reasons necessitating initiation of therapy. Corticosteroids, intravenous immunoglobulin, and anti-RhD immune globulin are typical first-line and rescue treatments, but these agents typically do not result in a durable remission in adult patients. Most patients requiring treatment therefore require subsequent line therapies, such as thrombopoietin receptor agonists (TPO-RAs), rituximab, fostamatinib, splenectomy, or a number of other immunosuppressive agents. In this focused review, we discuss management of adult ITP in the acute and chronic settings.

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Section: Rituximabmentioning

confidence: 99%

Management of Adult Patients with Immune Thrombocytopenia (ITP): A Review on Current Guidance and Experience from Clinical Practice

Song¹,

Al‐Samkari²

2021

JBM

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“…Unexpectedly, females were less likely to be dispensed TMP-SMX. Prior studies did not find that antibiotic prophylaxis differed according to patient sex in AAV [ 19 ] or in other systemic diseases treated with immunosuppressants [ 26 , 35 ] or RTX [ 27 , 36 ]. In a Japanese prospective inception cohort, the female sex was protective against serious infections in AAV (adjusted HR 0.47 [95% CI 0.25,0.89]) [ 6 ], and we observed a small but significant difference in serious infections (in the 6 months prior to RTX) between females (6%) and males (11%) in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Trimethoprim-sulfamethoxazole prophylaxis during treatment of granulomatosis with polyangiitis with rituximab in the United States of America: a retrospective cohort study

et al. 2023

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Background Antibiotic prophylaxis is recommended during ANCA-associated vasculitis (AAV) induction. We aimed to describe the frequency, persistence, and factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) use in an adult population sample with granulomatosis with polyangiitis (GPA) treated with rituximab (RTX). Methods We identified adults with GPA treated with RTX within the Merative™ Marketscan® Research Databases (2011–2020). TMP-SMX prophylaxis was defined as a $$\ge$$ ≥ 28-day prescription dispensed within a month of starting RTX. We estimated TMP-SMX persistence, allowing prescription refill gaps of 30 days. Multivariable logistic regression and Cox proportional hazards regression assessed the factors associated with baseline TMP-SMX use and persistence, respectively. Covariates included age, sex, calendar year, insurance type, immunosuppressant use, hospitalization, and co-morbidities. Results Among 1877 RTX-treated GPA patients, the mean age was 50.9, and 54% were female. A minority (n = 426, 23%) received TMP-SMX with a median persistence of 141 (IQR 83–248) days. In multivariable analyses, prophylaxis was associated with prednisone use in the month prior to RTX ($$\ge$$ ≥ 20 mg/day vs none, OR 3.96; 95% CI 3.0–5.2; 1–19 mg/day vs none, OR 2.63; 95% CI 1.8–3.8), and methotrexate use (OR 1.48, 95% CI 1.04–2.1), intensive care (OR 1.95; 95% CI 1.4–2.7), and non-intensive care hospitalization (OR 1.56; 95% CI 1.2–2.1) in the 6 months prior to RTX. Female sex (OR 0.63; 95% CI 0.5–0.8) was negatively associated with TMP-SMX use. Conclusions TMP-SMX was dispensed to a minority of RTX-treated GPA patients, more often to those on glucocorticoids and with recent hospitalization. Further research is needed to determine the optimal use and duration of TMP-SMX prophylaxis following RTX in AAV.

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“…Anyhow, we have to highlight that splenectomies were all performed >5 years since the SARS‐CoV2 infection and that none of the patients had previously been treated with rituximab. The impact of splenectomy on COVID‐19 is controversial, since this surgery procedure seems to increase more the risk of bacterial than viral infections; after rituximab, severe infections caused by hepatitis B virus, cytomegalovirus, Herpes zoster and Pneumocystis jirovecii have been reported and some clinicians prescribe prophylactic anti‐microbial therapy also in ITP cases [ 13 ]. Regarding patients on therapy, the low rate of infection in those treated with TPO‐RAs is consistent with data from literature showing relative safety of this class of drugs [ 14 , 15 ].…”

Section: Tablementioning

confidence: 99%

Immune thrombocytopenia management during COVID‐19 pandemic: An Italian monocentric experience

Lapietra

Ferretti

Baldacci

et al. 2022

eJHaem

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Over the last 2 years, different cases of immune thrombocytopenia (ITP) in patients affected by SARS‐CoV2 have been reported. The management of SARS‐CoV2 in subjects with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection. In this report, we describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID‐19, referred to the Haematology Institute of University Hospital Policlinico Umberto I in Rome. Steroids + immunoglobulins for ND or relapsed ITP and continuation of home therapy for chronic ITP are advised, although further knowledge is required.

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Antimicrobial prophylaxis in patients with immune thrombocytopenia treated with rituximab: a retrospective multicenter analysis

Cited by 3 publications

References 26 publications

Management of Adult Patients with Immune Thrombocytopenia (ITP): A Review on Current Guidance and Experience from Clinical Practice

Management of Adult Patients with Immune Thrombocytopenia (ITP): A Review on Current Guidance and Experience from Clinical Practice

Trimethoprim-sulfamethoxazole prophylaxis during treatment of granulomatosis with polyangiitis with rituximab in the United States of America: a retrospective cohort study

Immune thrombocytopenia management during COVID‐19 pandemic: An Italian monocentric experience

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