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

Legeay, Clément; Bittencourt, Henrique; Haddad, Élie; Spiesser-Robelet, Laurence; Thepot-Seegers, Valérie; Therrien, Roxane

doi:10.5863/1551-6776-22.5.369

Cited by 8 publications

(19 citation statements)

References 19 publications

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“…Rituximab is a chimeric mouse‐human monoclonal IgG1 kappa antibody against CD20 for mediating B‐cell depletion and is used for management of SLE and granulomatosis with polyangiitis . The most common HSR due to rituximab are infusion‐related reaction, which usually occurs at the first infusion (40%‐53.4%), decreasing dramatically in subsequent doses (2.7%) . The clinical presentation of infusion‐related reactions is usually low grade; however, they may resemble allergic reactions.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 The most common HSR due to rituximab are infusion-related reaction, which usually occurs at the first infusion (40%-53.4%), decreasing dramatically in subsequent doses (2.7%). 9,21 The clinical presenta- ously administrated BD. 23 The rationale for injection-site reaction is mainly mast cell degranulation due to high protein content and vehicle constituents of the drug.…”

Section: Patients With Hypersensitivity To a Bd (N = 6)mentioning

confidence: 99%

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Severe hypersensitivity reactions to biological drugs in children with rheumatic diseases

Soyer

Bilginer

Batu

et al. 2019

Pediatric Allergy Immunology

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Background: Hypersensitivity reactions (HSR) to biologic drugs (BD) may limit their use in children with rheumatic diseases. We aimed to analyze the incidence and clinical characteristics of immediate type I (IgE/non-IgE) hypersensitivity reactions to BD and the risk factors for these reactions.Methods: Children with rheumatic diseases using BD who were evaluated in the pediatric allergy department for possible drug hypersensitivity reaction (DHR) due to BD or any other drug were included in the study. Results: One hundred and twenty-eight children (49.2% boys; 14.6 years [9.9-16.9 years] with juvenile idiopathic arthritis [58%], familial Mediterranean fever [14%], vasculitis [14%], and other diseases [14%]) had used eight different BD with 32 494 infusions/injections. Fifteen patients were evaluated for DHR [injection-site reactions [n = 4], adverse events [n = 2], drug hypersensitivity other than BD [n = 3],and immediate BD hypersensitivity [n = 6]). The incidence of immediate BD HSR was 4.7%, with a clinical presentation of anaphylaxis in 3.9% (tocilizumab [n = 3], rituximab [n = 2], positive skin test with culprit BD [n = 3]). Among patients with BD HSR, the median follow-up was longer (84.5 vs 54 months, P = .048), and renal (33.3% vs 4.1%, P = .002), hematologic involvement (16.7% vs 0, P < .001), and active disease (83.3% vs 13.9%, P < .001) were more common. Logistic regression analysis revealed that renal involvement, more than 14 hospitalizations per lifetime, and more than two different BD used were associated with BD hypersensitivity. Conclusion:The frequency of severe immediate HSR due to BD was shown to be 3.9% in children with rheumatic diseases. Children with active rheumatic disease and who have exposure to multiple BD should be monitored for BD HSR, particularly during intravenous BD infusions. K E Y W O R D Sbiologic drugs, children, hypersensitivity, rheumatic diseases

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Section: Discussionmentioning

confidence: 99%

Section: Patients With Hypersensitivity To a Bd (N = 6)mentioning

confidence: 99%

Severe hypersensitivity reactions to biological drugs in children with rheumatic diseases

Soyer

Bilginer

Batu

et al. 2019

Pediatric Allergy Immunology

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“…The median number of doses of rapid rituximab infusion received per patient was 4 (range. [1][2][3][4][5][6][7][8][9][10][11][12]. All patients received a rituximab dose of 375 mg/m 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Because of the depletion of B cells after each dose, the risk of reaction decreases with subsequent administration in those who had previously tolerated the medication. 4 For example, 30% of patients are at risk for an infusion-related reaction (2% grade 3 or 4) by the fourth dose and only 14% are shown to be at risk by the eighth dose (0% grade 3 or 4), with the condition that all previous doses were tolerated. 3,5,6 As a result of the risk of infusion reactions, the first dose of rituximab in pediatrics is traditionally given slowly, administered at an initial rate of 0.5 mg/kg/hr for the first hour, and is gradually increased by 0.5 mg/kg/ hr every 30 minutes based on the patient's response (maximum rate of 50 mg/hr).…”

Section: Introductionmentioning

confidence: 99%

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Rapid-Infusion Rituximab in a Pediatric Population

Gaffney¹,

Dahl²,

Stanton³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES The use of rapid rituximab infusion in certain pediatric populations has generally been regarded as safe. The safety of our institution's rapid rituximab protocol was evaluated. METHODS The primary end point was the number of and severity of adverse drug reactions. Secondary end points included a description of the patient population defined by the indication, dose, and number of rituximab infusions administered. Additionally, the difference in infusion times in hours of those receiving rapid rituximab infusions versus the theoretical infusion time of subsequent administration rate schedules was defined. RESULTS A total of 88 infusions for 22 patients were reviewed. No dose-limiting adverse reactions were observed. Three patients experienced grade 1 isolated infusion-related adverse events during a single infusion encounter. Two of the three patients received additional doses of rapid rituximab infusions without incident, whereas the other patient no longer required rituximab therapy. CONCLUSIONS The use of a 90-minute rituximab infusion protocol in pediatric patients with non-rheumatic diseases was well tolerated.

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Infusion reactions associated with rituximab treatment for childhood-onset complicated nephrotic syndrome

et al. 2018

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

Cited by 8 publications

References 19 publications

Severe hypersensitivity reactions to biological drugs in children with rheumatic diseases

Severe hypersensitivity reactions to biological drugs in children with rheumatic diseases

Rapid-Infusion Rituximab in a Pediatric Population

Infusion reactions associated with rituximab treatment for childhood-onset complicated nephrotic syndrome

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