Systematic Review: Efficacy and Safety of Rituximab for Adults with Idiopathic Thrombocytopenic Purpura

Arnold, Donald M.; Dentali, Francesco; Crowther, Mark; Meyer, Ralph M.; Cook, Richard J.; Sigouin, Christopher; Fraser, Graeme; Lim, Wendy; Kelton, John G.

doi:10.7326/0003-4819-146-1-200701020-00006

Cited by 507 publications

(429 citation statements)

References 43 publications

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“…The results of our analysis confirm the short to mid-term effect of rituximab salvage therapy in adult patients with ITP reported earlier by our group and other authors [4][5][6][7][8][9][10][11][12]. Our data might suggest SD is the preferable therapeutic regimen due to the shorter timing of response, the higher response rate, the lower incidence of relapse, and the similar safety profile.…”

Section: Discussionsupporting

confidence: 90%

“…To date, there is not yet a gold standard regimen based on evidence, despite different schedules have been proposed, i.e., the standard dose (SD, 375 mg/m 2 weekly for four administrations), the low dose (LD, 100 mg flat dose weekly for four administrations) or 1,000 mg flat dose on day 1 and 15. Several reports addressed the therapeutic activity of rituximab in pediatric and adults patients with chronic refractory or steroid dependent ITP, with nearly 40-70% short term overall (OR) and 20-50% complete response (CR) according to different cohort selection [4][5][6][7][8][9][10][11]. Younger age and shorter period from diagnosis to rituximab have been pointed as possible good prognostic factors for response [7][8].…”

Section: Introductionmentioning

confidence: 99%

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Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Zaja¹,

Volpetti²,

Chiozzotto³

et al. 2012

American J Hematol

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We report the long-term outcome results of 57 consecutive adult patients with immune thrombocytopenia after being treated with rituximab. According to the different period of therapy, patients received either standard dose (SD) rituximab (i.e., 375 mg/m 2 weekly for 4 weeks) or low dose (LD) rituximab (i.e., 100 mg flat dose weekly for 4 weeks). Overall (OR) and complete response (CR) rates were 60 and 40%, respectively. Patients' median follow-up was 52 months, 82 months in the SD, and 44 months in the LD group; 15 out of 34 responsive patients (44%) relapsed, with median response duration of 24 months (range 3-120). The estimated 4-years event-free survival (EFS, considering events the non response status at month 2 or relapses in responders) was 30%. Patients who received SD vs. LD rituximab had better outcome with regard to short term response (OR 66 vs. 52%, CR 50 vs. 28%), relapse rate (38 vs. 54%), probability to achieve and maintain long-term response (41 vs. 24%) and estimated 4-years EFS (35 vs. 23%). Patients with a longer interval between diagnosis and rituximab therapy had worse EFS [HR 5 1.005; 95%IC: (1.002-1.009), P 5 0.019]. Three patients developed short-term adverse events, two-serum sickness, and one interstitial pneumonia. Four cases of malignancies and two herpes zoster reactivations were registered during long-term follow-up; one patient died for cerebral bleeding. Rituximab SD appears a safe and active agent allowing in nearly 40% of cases to achieve long-term response and splenectomy sparing effect. Am. J. Hematol. 87:886-889, 2012. V

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Zaja¹,

Volpetti²,

Chiozzotto³

et al. 2012

American J Hematol

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“…Of note, 21.6% of the patients experienced mild or moderate adverse events, and 3.7% experienced severe events, while 2.9% of deaths (even if not necessarily attributed to rituximab) were recorded. 42 Conversely, we never observed toxicity related to H pylori eradication treatment.…”

Section: Discussionmentioning

confidence: 58%

Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

Emilia

Luppi

Zucchini

et al. 2007

Blood

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“…Splenectomy is rarely performed in children given both the increased likelihood of spontaneous and/or therapyinduced remission and the increased infection-related morbidity and mortality [23]. Rituximab, a monoclonal anti-CD20 antibody, is an effective immunotherapeutic agent increasingly used to treat refractory ITP; however, its use is associated with infusion-related side effects [24,25], increased risk of the development of progressive multifocal leukoencephalopathy [26] and a greater incidence of infections [27].…”

Section: Treatment For Immune Thrombocytopeniamentioning

confidence: 99%

Eltrombopag: an update on the novel, non-peptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia

Kühne

Imbach

2010

Ann Hematol

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Immune thrombocytopenia (ITP) is characterised by a transient or persistent decrease in platelets accompanied by an increased risk of bleeding, which can have a significant negative impact on patients' health-related quality of life. The condition has long been associated with an increased rate of immune-mediated platelet destruction, and traditional treatments have targeted the reduction in platelet destruction; however, some interventional drugs are limited by transient efficacy and side effects. Recent advances in our understanding of ITP pathogenesis have highlighted the role of impaired platelet production, which has led to the advent of a new generation of thrombopoietin (TPO)-receptor agonist therapies, including eltrombopag and romiplostim. The oral, non-peptide TPO-receptor agonist eltrombopag has shown considerable promise in both preclinical and clinical trials. Eltrombopag has a unique mechanism of action and binds to a transmembrane region of the TPO receptor that is distant from the TPO binding site. As such, eltrombopag may confer synergistic effects with endogenous TPO rather than competing for binding. Eltrombopag also induces activation of the TPO receptor and downstream signalling in a distinct manner to TPO and does not have a significant impact on platelet function. Clinical evidence demonstrates that eltrombopag produces a rapid and sustainable increase in platelet counts that significantly reduces bleeding and is well tolerated in patients with ITP. Eltrombopag therefore represents an important addition to the therapeutic armamentarium for ITP.

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Systematic Review: Efficacy and Safety of Rituximab for Adults with Idiopathic Thrombocytopenic Purpura

Cited by 507 publications

References 43 publications

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia

Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

Eltrombopag: an update on the novel, non-peptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia

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