Rapid Infusion Rituximab Changing Practice for Patient Care

Abstract

Rituximab is a chimeric anti-CD20 monoclonal antibody. Its intravenous administration is associated with substantial infusion related-toxicity. Recommended infusion durations are prolonged (average 5-6 h for first infusion and 3-4 h for subsequent infusions). We aimed to explore the safety and tolerability of short infusion rituximab, (over 90 min), in Non-Hodgkin's lymphoma patients at Riyadh Military Hospital. Adult oncology patients diagnosed with Non-Hodgkin's lymphoma, who were to receive rituximab, were included in the study. The schedule of administration for cycle one was unaltered and delivered according to the product monograph (5-6 h). All subsequent cycles were administered over a total infusion time of 90 min (20% of the dose in the first 30 min then the remaining 80% over 60 min, total dose delivered in 500 mL sodium chloride). All patients were observed for infusion related reactions during the rituximab infusion and for 30 min after the infusion. In addition, all patients were advised to report any reaction occurring within 24 h after rituximab infusion.From April 2007 to September 2007, 21 patients with non-Hodgkin's lymphoma were treated with rituximab-based chemotherapy. A total of 126 infusions were administered with average of 6 infusions per patient. The majority of patients were treated with CHOP-Rituximab or CHOP-like regimen. The 90-min Rituximab infusion schedule was well tolerated with no grade 3/4 infusion related adverse events observed. A rapid infusion rituximab over 90 min is well tolerated and safe when administered as the second and subsequent infusions in the course of therapy. This shortened infusion schedule has resulted in a substantial reduction in resource utilization. Our institution has adopted this as routine practice.

Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

“…Their frequency is reduced by the use of concomitant intravenous steroids1–3 (category Ia; www.accessdata.fda.gov/scripts/cder/drugsatfda, www.ema.eu.int/humans/Humans/EPAR/mabthera/mabthera). 33 There have been several reports from haematology experience on the safety of shortened (60–90 min) infusion times 95–99…”

Safety of rapid rituximab infusion in adult cancer patients: A systematic review

“…A 90 or 60 min rapid infusion regimen has been adopted as a standard administration rate for non‐Hodgkin lymphoma (NHL) and chronic lymphocytic leukaemia (CLL) in second and subsequent infusions in a number of centres 1–3 . However, rapid rituximab administration is not in accordance with the pharmaceutical manufacturers guidelines 4 .…”

Rapid infusion of rituximab is well tolerated in children with hematologic, oncologic, and rheumatologic disorders

“…The incidence of infusion‐related reactions during rapid infusion administration is comparable to standard infusion rates in patients who successfully tolerate their first infusion . Limited reports of rapid infusions in small numbers of children with autoimmune hemolytic anemia (AIHA), chronic immune thrombocytopenia (ITP), and following hematopoietic stem cell transplant demonstrate similar safety and efficacy data as seen in adult studies .…”

“…No grade 3 or 4 reactions and no increase in minor infusion reactions were observed . Further data involving rapid infusion of rituximab given over 60–90 minutes has demonstrated the safety and tolerability of this approach, prompting the approval of FDA 90‐min infusion in the package labeling for patients receiving glucocorticoid‐based treatment regimens …”