Infusion-related reactions to rituximab: frequency, mechanisms and predictors

Paul, Franciane; Cartron, Guillaume

doi:10.1080/1744666x.2019.1562905

Cited by 64 publications

(63 citation statements)

References 52 publications

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Section: Introductionmentioning

confidence: 99%

“…Mild-to-moderate infusion-related reactions (IRRs) are the most common adverse event (AE) associated with rituximab administration [1,2,26]. Most IRRs (77%) occur during or after the first rituximab infusion [1,2,26]. Premedication with acetaminophen, along with antihistamines and corticosteroidcontaining prophylaxis, can reduce the incidence and severity of IRRs [1,2,26].…”

Section: Introductionmentioning

confidence: 99%

“…Most IRRs (77%) occur during or after the first rituximab infusion [1,2,26]. Premedication with acetaminophen, along with antihistamines and corticosteroidcontaining prophylaxis, can reduce the incidence and severity of IRRs [1,2,26].…”

Section: Introductionmentioning

confidence: 99%

“…The predictive factors of rituximab IRR AEs are not well understood. Previously, Paul and Cartron [26] reported lymphocyte count, bulky disease, low-grade B-cell NHL, the level of CD20 expression on CLL cells, and Fc/Fc gamma receptor (FcγR)-mediated interactions between natural killer (NK) cells and CD20+ cells as being associated with the occurrence of IRRs. In the observational setting in patients with hematologic malignancies, predictive indicators of rituximab IRRs have included bone marrow involvement, body weight, low-grade lymphomas, and bulky disease [27][28][29].…”

Section: Introductionmentioning

confidence: 99%

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Factors Influencing Infusion-Related Reactions Following Dosing of Reference Rituximab and PF-05280586, a Rituximab Biosimilar

et al. 2021

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Background Infusion-related reactions (IRRs) are the most common adverse event (AE) associated with infusion of rituximab, an anti-CD20 monoclonal antibody. Objective Our objective was to evaluate the impact of dosing/infusion patterns and certain baseline characteristics on IRR occurrence during the first rituximab infusion administered as the biosimilar PF-05280586 (RTX-PF) or reference rituximab sourced from the EU (RTX-EU, MabThera ® ) in patients with CD20+ low-tumor-burden follicular lymphoma. Patients and methods Rituximab (RTX-PF, n=196; RTX-EU, n=198) was administered (375 mg/m 2 ) on days 1, 8, 15, and 22 (one cycle), with a follow-up period through 52 weeks. The relationships between infusion rate, drug exposure, and IRR incidence were assessed by logistic regression analysis and pharmacokinetic modeling and simulation. Baseline CD20 level, antidrug antibody (ADA) status, and tumor burden according to IRR occurrence (yes/no) were compared descriptively. Results Median rituximab infusion duration on day 1 was 3.50 h for each of the two groups. There was a positive correlation between infusion rate and all-grade IRRs occurring within 24 h after infusion (p < 0.0001). Patients who developed IRRs had a higher median baseline CD20+ level. IRR incidence was unaffected by baseline ADA status. Drug exposure did not predict IRR incidence. Baseline tumor burden was similar between patients with and without IRRs. Conclusions Results of this analysis provide a better understanding of IRRs after the first rituximab (RTX-PF or RTX-EU) infusion and demonstrate a potential correlation of infusion rate and other factors with IRR at the individual and population levels. Infusion-rate escalation steps continue to be needed to manage IRRs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Influencing Infusion-Related Reactions Following Dosing of Reference Rituximab and PF-05280586, a Rituximab Biosimilar

et al. 2021

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“…The frequency of these events rapidly decreases with the second rituximab infusion and pre-medication (6). The underlying mechanism is related to complement and cytokine activation and they appear more frequently in patients with hematologic malignancies than in those who receive rituximab for the treatment of autoimmune diseases (54). The management of acute infusion reactions consists of stopping the rituximab infusion plus paracetamol, diphenhydramine (which are usually given as premedication) and IV steroids (55).…”

Section: Infusion Reactionsmentioning

confidence: 99%

Lessons for rituximab therapy in patients with rheumatoid arthritis

Garcia-Montoya

Villota‐Eraso

Yusof

et al. 2020

The Lancet Rheumatology

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B-cell depletion therapy is an effective option for RA treatment, but depletion is frequently incomplete (>0.0001x10 9 /L at week 2). Complete B-cell depletion (CD) after rituximab is associated with good clinical response (R) and this status (CD-R) leads to long-term maintenance of therapy. Low pretreatment plasmablasts, concomitant DMARDs, no smoking exposure, ACPA/RF+ and a low IFNsignature are predictive of CD-R. Half of the patients that achieve CD-R with rituximab eventually stop experiencing this outcome to further infusions; however 3/4 of them regain it in the following cycle. This suggests that loss of response is reversible and patients can still benefit from rituximab retreatment. Efficacy of lower doses of rituximab is under investigation, but preliminary results suggest these strategies are best used for maintenance especially in patients who suffer adverse events or are at high risk of infection. Infusion reactions are the most common adverse events; and IgG monitoring is crucial as low levels correlate with higher infection risk.

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