The efficacy and safety of low-dose rituximab in immune thrombocytopenia: a systematic review and meta-analysis

Li, Yunjie; Shi, Yuye; He, Zhengmei; Chen, Qiuni; Liu, Zhenyou; Yu, Liang

doi:10.1080/09537104.2019.1624706

Cited by 29 publications

(30 citation statements)

References 30 publications

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“…Reduced-dose regimens of 100 mg weekly for 4 weeks have demonstrated satisfactory efficacy in other autoimmune disorders, including immune thrombocytopenia. 30 Other studies have indicated that low-dose therapy may have comparable efficacy to higher doses in TTP. 19,29 A prospective multicenter single-arm phase II study enrolled 24 patients with refractory TTP, who received 2 or 3 doses of rituximab 375 mg/m 2 (on days 1 and 4, and then on day 15 if B lymphocytes remained detectable).…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of refractory thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus with combination of plasma exchange and low-dose rituximab

Bai

et al. 2020

Lupus

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Objectives Thrombotic thrombocytopenia purpura (TTP) associated with systemic lupus erythematous (SLE) (i.e., SLE-TTP) is a rare life-threatening disease often requiring intensive immunosuppressive agents, in addition to high-dose corticosteroids and plasma exchange (PEX). The optimal therapy of rituximab is unclear, but 375 mg/m2 weekly for 4 weeks is the usual practice, adopted from regimens for non-Hodgkin’s lymphoma. We reported two cases of refractory SLE-TTP that showed good efficacy and prognosis with combination of methylprednisolone (MP) pulse, plasma exchange and low-dose rituximab (100 mg weekly for 4 weeks) treatment. Methods Clinical data and treatment outcomes were reviewed of two patients diagnosed with refractory SLE-TTP at Peking Union Medical College Hospital between July 2017 and July 2018. Results Both patients had SLE and presented with microangiopathic anemia and thrombocytopenia. Laboratory assays revealed high anti-nuclear antibody titers, reduced complement 3 and 4 levels, proteinuria, significantly elevated lactate dehydrogenase, schistocytes on peripheral blood smear, low ADAMTS13 activity, and the presence of ADAMTS13 inhibitor. In both patients, platelet counts remained below 50 × 109/L after MP pulse and 6 PEXs, confirming the diagnosis of refractory SLE-TTP. Low-dose rituximab (100 mg weekly for 4 weeks) was administered in both cases, resulting in normalization of platelet counts and significant reductions in B-lymphocyte counts. No TTP relapse or SLE flare occurred during 24 months of follow-up. Conclusions Our cases confirmed the efficacy and good follow-up outcomes of low-dose rituximab treatment (100 mg weekly for 4 weeks) for refractory SLE-TTP.

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Section: Discussionmentioning

confidence: 99%

Successful treatment of refractory thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus with combination of plasma exchange and low-dose rituximab

Bai

et al. 2020

Lupus

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“…For patients who failed the first-line treatment, rituximab and thrombopoietic agents could be used. Rituximab is a monoclonal anti-CD20 antibody which can induce remission in approximately 60% of ITP patients at the recommended dosage of 375 mg/m 2 weekly for 4 weeks [21,22]. Due to the potential toxicity, several studies assessed lower dosing schedules.…”

Section: Discussionmentioning

confidence: 99%

The association between antinuclear antibody and response to rituximab treatment in adult patients with primary immune thrombocytopenia

Wang

Lei

et al. 2020

Hematology

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Background: Antinuclear antibodies (ANAs) can be detected in about 30% of patients with primary immune thrombocytopenia (ITP), yet their relationship with treatment response to rituximab remains elusive. Methods: we retrospectively reviewed the clinical records of hospitalized adult ITP patients who were treated with rituximab from three medical centers across China. Rituximab was given intravenously at 100 mg weekly for 4 weeks, or at a single dose of 375 mg/m 2. All included patients had their ANAs tested before rituximab treatment. Results: A total of 287 patients fulfilled the inclusion criteria and were eligible for analysis. ANAs were positive in 98 (34.1%) of the included patients. The incidence of overall response and complete response (CR) in ANA-positive patients was significantly higher than that in ANAnegative patients (overall response: 76.5% vs. 55.0%, P < 0.001; CR: 46.9% vs. 29.1%, P = 0.003). However, sustained response (SR) rates in ANA-positive patients at 6, 12 and 24 months were all lower compared with ANA-negative patients (all P < 0.05). The overall duration of response (DOR) estimated by Kaplan-Meier analysis in ANA-negative patients was greater than that in ANA-positive patients (P < 0.001). Conclusion: ITP patients with positive ANA test were likely to achieve a better initial response to rituximab treatment, while their long-term outcome was unfavorable. Therefore, ANA test could be useful for predicting rituximab response in ITP.

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“…Low dose rituximab therapy has been recommended to avoid treatment related adverse events. A recent systematic review found an overall response rate of 63% and complete response rate of 44% in ITP patients treated with low-dose (100 mg or 100 mg/m 2 per week for 4 weeks) rituximab instead of the standard dose of 375 mg/m 2 per week for 4 weeks [133]. Low dose rituximab has a satisfactory efficacy and safety profile [133].…”

Section: Immunomodulatorsmentioning

confidence: 99%

“…A recent systematic review found an overall response rate of 63% and complete response rate of 44% in ITP patients treated with low-dose (100 mg or 100 mg/m 2 per week for 4 weeks) rituximab instead of the standard dose of 375 mg/m 2 per week for 4 weeks [133]. Low dose rituximab has a satisfactory efficacy and safety profile [133]. In a long-term follow-up study (median follow-up of 6 years), median duration of response was longer (17 months vs. 11 months), and splenectomy rate was lower (17.2% vs. 26.4) in rituximab-treated patients.…”

Section: Immunomodulatorsmentioning

confidence: 99%

Primary Immune Thrombocytopenia: Novel Insights into Pathophysiology and Disease Management

Singh¹,

Uzun²,

Bakchoul³

2021

JCM

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Immune thrombocytopenia (ITP) is an autoimmune disorder defined by a significantly reduced number of platelets in blood circulation. Due to low levels of platelets, ITP is associated with frequent bruising and bleeding. Current evidence suggests that low platelet counts in ITP are the result of multiple factors, including impaired thrombopoiesis and variations in immune response leading to platelet destruction during pathological conditions. Patient outcomes as well as clinic presentation of the disease have largely been shown to be case-specific, hinting towards ITP rather being a group of clinical conditions sharing common symptoms. The most frequent characteristics include dysfunction in primary haemostasis and loss of immune tolerance towards platelet as well as megakaryocyte antigens. This heterogeneity in patient population and characteristics make it challenging for the clinicians to choose appropriate therapeutic regimen. Therefore, it is vital to understand the pathomechanisms behind the disease and to consider various factors including patient age, platelet count levels, co-morbidities and patient preferences before initiating therapy. This review summarizes recent developments in the pathophysiology of ITP and provides a comprehensive overview of current therapeutic strategies as well as potential future drugs for the management of ITP.

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The efficacy and safety of low-dose rituximab in immune thrombocytopenia: a systematic review and meta-analysis

Cited by 29 publications

References 30 publications

Successful treatment of refractory thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus with combination of plasma exchange and low-dose rituximab

Successful treatment of refractory thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus with combination of plasma exchange and low-dose rituximab

The association between antinuclear antibody and response to rituximab treatment in adult patients with primary immune thrombocytopenia

Primary Immune Thrombocytopenia: Novel Insights into Pathophysiology and Disease Management

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