Rituximab for subcutaneous delivery: Clinical management principles from a nursing perspective

Abstract

Nurses play an integral role in administering treatments to patients with non-Hodgkin's lymphomas. Intravenous (IV) rituximab was approved by the Australian Therapeutic Goods Administration in 1998, and a novel subcutaneous (SC) formulation was approved in 2014. Fixed-dose SC rituximab is highly concentrated; co-formulation with a fully human recombinant vorhyaluronidase alfa enzyme helps overcome the physiological barriers of the SC space, facilitating drug dispersion. Despite a different pharmacokinetic profile to the IV preparation, SC rituximab demonstrates a comparable efficacy/safety profile. Most frequently occurring rituximab-related adverse events include neutropenia, nausea and constipation, and administration-related reactions are more frequent with the SC preparation. Compared with IV, SC delivery reduces treatment times and nurse workload, and patients report greater comfort and convenience.This article sets out nursing considerations for optimal administration of SC rituximab, including premedication, drug handling/preparation, injection technique, after-care and management of adverse events, particularly administration-related reactions.

A Multidisciplinary Perspective on the Subcutaneous Administration of Trastuzumab in HER2-Positive Breast Cancer

“…26 absorption of large volumes of solution 10,11 . The degradation of the extracellular matrix is temporary and facilitates injection of the solution with minimal tissue distortion, edema, or tissue irritation 12 . In contrast to the iv formulation of trastuzumab, the sc formulation does not require a loading dose and weight-adjusted dosing, simplifying administration by removing the need for reconstitution or dose calculation on the basis of body weight.…”

A Canadian Perspective on the Subcutaneous Administration of Rituximab in Non-Hodgkin Lymphoma

“…Although sc administration of therapeutic agents can offer a number of advantages over IV administration, the technique is limited by the interstitial matrix, which physiologically restricts both the rate of delivery and the volume that can be injected 5 . To overcome that barrier, the sc formulation of rituximab is highly concentrated to reduce the volume to 11.7 mL and contains 8-recombinant human hyaluronidase alfa, an enzyme that temporarily degrades the extracellular matrix to facilitate the absorption of large volumes 5,6 .…”

“…To overcome that barrier, the sc formulation of rituximab is highly concentrated to reduce the volume to 11.7 mL and contains 8-recombinant human hyaluronidase alfa, an enzyme that temporarily degrades the extracellular matrix to facilitate the absorption of large volumes 5,6 . The degradation of the extracellular matrix is temporary and allows for the injection of rituximab with minimal tissue distortion, edema, or tissue irritation 5 . Any changes to the extracellular matrix are reversible within 24 hours after the injection.…”

“…Rituximab for sc administration is provided in readyto-use, single-dose (1400 mg) vials containing 11.7 mL of sterile, non-pyrogenic, preservative-free solution (no dilution required) 5,18 . When prepared under aseptic conditions, sc rituximab is physically and chemically stable in a syringe for up to 48 hours at 2°C-8°C or up to 8 hours at room temperature.…”

“…The first dose of rituximab should always be given intravenously, with the sc formulation being started from the 2nd cycle only once the patient is seen to be able to receive a complete IV dose 5,18 . The reasons for that strategy are that arrs are most likely to occur with the first dose, and the chances of such reactions occurring subsequently are very low.…”