Pediatric rheumatology infusion center: report on therapeutic protocols and infusions given over 4 Years with focus on adverse events over 1 Year

Abstract

BackgroundChildren with chronic rheumatic disease often require intravenous (IV) therapy. Our center has instituted standardized protocols for use of IV medications in rheumatology patients. Herein, we introduce the therapeutic protocols and report on their short-term safety.MethodsThis was an institutional review board (IRB) approved retrospective chart review of all patients who had received IV infusions between the years 2012 and 2015 at a single center, prescribed by a pediatric rheumatologist. Infusion medications included abatacept, belimumab, cyclophosphamide, immune globulin, infliximab, methylprednisolone, N-acetylcysteine, pamidronate disodium, rituximab, and tocilizumab. For calendar year 2015, all adverse infusions reactions were recorded along with treatment strategies used to manage them, and outcomes. Rates of adverse events were calculated per infusion medication.ResultsDuring calendar years 2012–2015, 7585 IV infusions were administered to 398 unique patients. In the year 2015, 2187 infusions were administered to 224 patients, with 34 patients experiencing 41 infusion reactions (1.9% of all infusions). Rituximab had the highest rate of adverse drug reactions with 10 patients experiencing reactions during 106 infusions (9.4%). None of the reactions were life-threatening, and only 6 resulted in discontinuation of therapy.ConclusionsIn a recent 4-year span, the UAB Pediatric Rheumatology Infusion Center has given thousands of IV infusions with minimal adverse reactions over a one-year reporting period. The combination of standard infusion protocols, experience of and communication between physicians and nurses who staff the center, and safety of the medications themselves, allows for safe IV administration of a variety of therapies for pediatric rheumatology patients.Trial registrationNot applicable; this was a retrospective study.Electronic supplementary materialThe online version of this article (10.1186/s12969-018-0234-0) contains supplementary material, which is available to authorized users.

Patterns of B Cell Repletion Following Rituximab Therapy in a Pediatric Rheumatology Cohort

“…This retrospective study has several limitations, most notably the lack of a literature consensus on the definition of depletion and repopulation. The cutoff definitions for CD19 levels for this study were chosen based on clinical practice and isolated literature . Thiel et al set the repopulation level lower at CD19 counts 70 cells/μL or higher and defined depletion as fewer than 1 cell/μL .…”

“…RTX was dosed per institutional practice and was given as two infusions separated by two weeks, each with a dose of 750 mg/m 2 (maximum, 1 g) . The two doses combined comprised one round.…”

“…RTX is generally well‐tolerated. The most common adverse event reported is infusion reactions, which are thought to be related to the rate of infusion , but another potential adverse event is infection. Progressive multifocal leukoencephalopathy (PML) is a rare and potentially fatal disease caused by the John Cunningham virus.…”

“…Hypogammaglobinemia can occur in the months following RTX infusion with a mean onset of about 8 months . Replacement with intravenous immunoglobulin (IVIg) can help reduce the risk of infection . Late‐onset neutropenia has also been reported several weeks after RTX infusion in adult patients, more often in those treated for hematologic disease and less commonly reported in patients with rheumatic disease .…”

Rituximab treatment for chronic steroid-dependent Henoch-Schonlein purpura: 8 cases and a review of the literature

“…Each round of intravenous RTX was given as 2 doses of 750 mg/m 2 (maximum of one gram) per dose, given 2 weeks apart [ 33 ]. RTX was given in conjunction with high dose intravenous pulse CS (30 mg/kg, maximum of one gram) to decrease the risk of an allergic reaction to RTX [ 34 ]. The number of hospitalizations for HSP before and after the administration of the first course of RTX were compared using the Wilcoxon signed rank test.…”