Rituximab plus standard of care for treatment of primary immune thrombocytopenia: a systematic review and meta-analysis

Chugh, Shaan; Darvish-Kazem, Saeed; Lim, Wendy; Crowther, Mark; Ghanima, Waleed; Wang, Grace; Heddle, Nancy M.; Kelton, John G.; Arnold, Donald M.

doi:10.1016/s2352-3026(15)00003-4

Cited by 105 publications

(86 citation statements)

References 42 publications

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“…However, a recent metaanalysis did not find an increased risk of infection. 12 Our study confirms these reassuring data with an incidence of severe infections of two cases/100 patient-years. This incidence rate is in the lower range of the severe infections rate observed in other autoimmune diseases treated with rituximab and particularly in large cohorts of patients with RA (1.5-7.9/100 patient-years).…”

Section: Discussionsupporting

confidence: 87%

“…Over the past 20 years, rituximab has been considered a valid off-label second-line option in most guidelines, 5,6 with a 60% initial response in adult ITP. [7][8][9][10][11][12][13] Nevertheless, the estimated fiveyear response rate, based on pooled retrospective data, is only about 20% among adults, and no robust predictor of long-term response has been demonstrated. 14 Assessing the tolerance and particularly the potential risk of severe infection with rituximab is also crucial.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP‐ritux

et al. 2019

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Long‐term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP‐ritux

et al. 2019

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“…55 Unfortunately, the long-term response rates with rituximab are not as good as splenectomy with sustained response of ;20% at 5 years post initial rituximab treatment. 68 A recent trial in 112 adult patients comparing standard dosing of rituximab and placebo showed no difference in complete remission at 1.5 years. 69 Many patients who initially respond to rituximab can respond to subsequent doses; however, the safety and efficacy of repeated dosing of rituximab have not been systematically evaluated.…”

mentioning

confidence: 99%

Clinical updates in adult immune thrombocytopenia

Lambert

Gernsheimer

2017

Blood

339

319

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Immune thrombocytopenia (ITP) occurs in 2 to 4/100 000 adults and results in variable bleeding symptoms and thrombocytopenia. In the last decade, changes in our understanding of the pathophysiology of the disorder have led to the publication of new guidelines for the diagnosis and management of ITP and standards for terminology. Current evidence supports alternatives to splenectomy for second-line management of patients with persistently low platelet counts and bleeding. Long-term follow-up data suggest both efficacy and safety, in particular, for the thrombopoietin receptor agonists and the occurrence of late remissions. Follow-up of patients who have undergone splenectomy for ITP reveals significant potential risks that should be discussed with patients and may influence clinician and patient choice of second-line therapy. Novel therapeutics are in development to address ongoing treatment gaps.

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“…Rituximab is still used off-label as a second- or third-line option in many countries. Only a few systematic reviews on the efficacy of rituximab for adult ITP patients have been published [6,16]. In the meta-analysis by Arnold et al, overall response (OR) and complete response (CR) rates with rituximab were 62.5% and 46.2%, respectively, with a median response duration of 10.5 months and a median follow-up of 9.5 months [6].…”

Section: Introductionmentioning

confidence: 99%

“…In the meta-analysis by Arnold et al, overall response (OR) and complete response (CR) rates with rituximab were 62.5% and 46.2%, respectively, with a median response duration of 10.5 months and a median follow-up of 9.5 months [6]. In a recent systematic review and meta-analysis including non-splenectomized ITP patients treated with rituximab, a CR rate of 46.8% was reported after a median follow-up of 6 months [16]. Khellaf et al conducted a prospective multicenter registry of adult patients with ITP who were refractory to corticosteroids (97%), IVIG (71%), and splenectomy (10%) and were treated with rituximab [17].…”

Section: Introductionmentioning

confidence: 99%

Rituximab Therapy in Adults with Refractory Symptomatic Immune Thrombocytopenia: Long-Term Follow-Up of 15 Cases

Hindilerden

Yonal-Hindilerden²,

Yenerel³

et al. 2017

Tjh

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Objective:This paper prospectively evaluates the long-term follow-up [mean ± standard deviation (SD) duration: 89.7±19.4 months] data of 15 patients (13 females and 2 males) with refractory symptomatic immune thrombocytopenia (ITP) treated with rituximab.Materials and Methods:Rituximab was administered at 375 mg/m2 weekly for a total of 4 doses. Complete response (CR) was defined as a platelet count of ≥100,000/mm3 and partial response (PR) as a platelet count of ≥30,000/mm3 but less than 100,000/mm3. Early response (ER) and late response (LR) were defined as response within 42 days and after 42 days of initiation of rituximab therapy, respectively. Sustained response (SR) was defined as response lasting for at least 6 months.Results:Mean age (±SD) at the start of rituximab was 46.6±11.3 years. Mean platelet count (±SD) prior to rituximab treatment was 17,400±8878/mm3. The mean time (±SD) between rituximab therapy and response to rituximab in early responders and late responders was 1.8±1.3 weeks and 10±2.8 weeks, respectively. Mean durations (±SD) of ER and LR were 51±47.2 months and 6±4.2 months, respectively. Seven of the 15 patients (46.7%) showed an initial response to rituximab (5 ER and 2 LR). The rate of SR over 6 months was 26.7% (4/15). Among the responders to rituximab, 3 (3/7, 42.9%) maintained their response 1 year after rituximab treatment and 2 (2/7, 28.6%) had ongoing response 5 years after initiation of rituximab. Two of the 7 patients (28.6%) still maintained their response 98 months after initiation of rituximab. All 5 initial responders with subsequent relapse achieved response from subsequent treatment modalities (3 CR, 2 PR).Conclusion:Our data confirm, over a long period of observation, that rituximab is safe and effective in the management of patients with chronic refractory primary ITP.

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Rituximab plus standard of care for treatment of primary immune thrombocytopenia: a systematic review and meta-analysis

Cited by 105 publications

References 42 publications

Long‐term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP‐ritux

Long‐term safety and efficacy of rituximab in 248 adults with immune thrombocytopenia: Results at 5 years from the French prospective registry ITP‐ritux

Clinical updates in adult immune thrombocytopenia

Rituximab Therapy in Adults with Refractory Symptomatic Immune Thrombocytopenia: Long-Term Follow-Up of 15 Cases

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