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Hartung HP, Berger T, Bermel RA, Brochet B, Carroll WM, Holmøy T, Karabudak R, Killestein J, Nos C, Patti F, Perrin Ross A, Vanopdenbosch L, Vollmer T, Buffels R, Garas M, Kadner K, Manfrini M, Wang Q, Freedman MS. ENSEMBLE PLUS: final results of shorter ocrelizumab infusion from a randomized controlled trial. J Neurol 2024; 271:4348-4360. [PMID: 38649522 PMCID: PMC11233283 DOI: 10.1007/s00415-024-12326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/16/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Ocrelizumab is an approved intravenously administered anti-CD20 antibody for multiple sclerosis (MS). The safety profile and patient preference for conventional versus shorter ocrelizumab infusions were investigated in the ENSEMBLE PLUS study. METHODS ENSEMBLE PLUS was a randomized, double-blind substudy to the single-arm ENSEMBLE study (NCT03085810), comparing outcomes in patients with early-stage relapsing-remitting MS receiving ocrelizumab 600 mg over the approved 3.5-h (conventional) versus 2-h (shorter) infusion. The primary endpoint was the proportion of patients with infusion-related reactions (IRRs) following the first randomized dose (RD); the secondary endpoint included IRR frequency at subsequent RDs. RESULTS At first RD, the number of patients with an IRR in the conventional (101/373; 27.1%) versus shorter (107/372; 28.8%) infusion group was similar (difference, stratified estimates [95% CI]: 1.9% [- 4.4, 8.2]). Most IRRs (conventional: 99.4%; shorter: 97.7%) were mild/moderate. IRR frequency decreased over the course of RDs; three patients discontinued from the shorter infusion arm but continued with conventional infusion. Overall, > 98% of IRRs resolved without sequelae in both groups. Pre-randomization throat irritation was predictive of future throat irritation as an IRR symptom. Adverse events (AEs) and serious AEs were consistent with the known ocrelizumab safety profile. On completion of ENSEMBLE PLUS, most patients chose to remain on (95%) or switch to (80%) shorter infusion. CONCLUSION ENSEMBLE PLUS demonstrates the safety and tolerability of shorter ocrelizumab infusions. Most patients remained on/switched to shorter infusion after unblinding; IRRs did not strongly influence patient decisions. CLINICAL TRIALS REGISTRATION Substudy of ENSEMBLE (NCT03085810). REGISTRATION March 21, 2017.
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Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, UKD, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
- Department of Neurology, Palacky University Olomouc, Olomouc, Czech Republic.
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Robert A Bermel
- Mellen Center for MS, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruno Brochet
- INSERM U 1215, Neurocentre Magendie, University of Bordeaux, Bordeaux, France
| | - William M Carroll
- Department of Neurology, Sir Charles Gairdner Hospital, Perron Institute for Neurological and Translational Science, The University of Western Australia, Nedlands, Australia
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rana Karabudak
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carlos Nos
- Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, UOS Sclerosi Multipla Policlinico G Rodolico, University of Catania, Catania, Italy
| | | | | | - Timothy Vollmer
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Regine Buffels
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
- , Basel, Switzerland
| | | | | | | | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Mark S Freedman
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Davies A, Kater AP, Sharman JP, Stilgenbauer S, Vitolo U, Klein C, Parreira J, Salles G. Obinutuzumab in the treatment of B-cell malignancies: a comprehensive review. Future Oncol 2022; 18:2943-2966. [PMID: 35856239 PMCID: PMC11284610 DOI: 10.2217/fon-2022-0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
The type II anti-CD20 antibody obinutuzumab has structural and mechanistic features that distinguish it from the first anti-CD20 antibody, rituximab, which have translated into improved efficacy in phase III trials in indolent non-Hodgkin lymphoma and chronic lymphocytic leukemia (CLL). These gains have been shown through improvements in, and/or increased durability of, tumor response, and increases in progression-free survival in patients with CLL or follicular lymphoma (FL). Ongoing research is focusing on the use of biomarkers and the development of chemotherapy-free regimens involving obinutuzumab. phase II trials of such treatment regimens have shown promise for CLL, FL and mantle cell lymphoma, while phase III trials have highlighted obinutuzumab as the antibody partner of choice for novel agents in first-line CLL treatment.
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MESH Headings
- Adult
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Follicular/drug therapy
- Lymphoma, Non-Hodgkin/drug therapy
- Rituximab/therapeutic use
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Affiliation(s)
- Andrew Davies
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Arnon P Kater
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jeff P Sharman
- Willamette Valley Cancer Institute & Research Center & US Oncology, Eugene, OR 97401, USA
| | - Stephan Stilgenbauer
- Comprehensive Cancer Center Ulm, Early Clinical Trials Unit (ECTU), Ulm, & Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | | | - Gilles Salles
- Memorial Sloan Kettering Cancer Center, Department of Medicine, NY 10021, USA
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Bishton M, Marshall S, Harchowal J, Salles G, Golfier C, Tucci A, Fernández AR, Sanchez Blanco JJ, Bocchia M, Kim S, Lee YN, Zinzani PL. The safety and clinical effectiveness of rapid infusion with CT-P10 in patients with non-Hodgkin's lymphoma or chronic lymphocytic leukemia: A retrospective non-interventional post-authorization safety study in Europe. Hematol Oncol 2022; 40:370-380. [PMID: 35168291 PMCID: PMC9545983 DOI: 10.1002/hon.2978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/08/2022]
Abstract
Rapid infusion (RI) of the rituximab biosimilar CT-P10 is currently only an approved treatment regimen for the treatment of rheumatoid arthritis. Although both CT-P10 and reference rituximab are known to be frequently administered using a RI regimen (≤90 min) in clinical practice, published data on the safety of RI of CT-P10 in patients with NHL and CLL are limited. Hence, this study collected real-world safety and effectiveness data on RI-CT-P10 from the medical records of 196 patients with NHL or CLL in 10 European centers, 6 months after the date of the first RI (index date); the infusion-related reaction (IRR) rate was compared to previously published data. Ten percent (95% confidence interval 6%-15%; n = 20/196) of patients experienced an infusion-related reaction (IRR) on day 1-2 post-index, which was not significantly different (p = 0.45) to the IRR rate for rituximab described in a previous meta-analysis (8.8%). During the observation period, 2% of patients experienced grade 3-5 IRRs and 85% (n = 166) experienced an adverse event (non-IRR). The most common reason for discontinuation of first-line CT-P10 was planned treatment completion (81%; n = 158). Complete response and partial response to CT-P10 was observed in 74% (n = 142/192) and 22% (n = 42/192) of patients, respectively. The results of this real-world study demonstrate that the safety and effectiveness profile of RI-CT-P10 is similar to RI of reference rituximab and therefore support the current use of RI-CT-P10 in patients with NHL and CLL.
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Affiliation(s)
- Mark Bishton
- Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Scott Marshall
- Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - Gilles Salles
- Centre Hospitalier Lyon Sud - Service d'Hématologie Clinique, Lyon, France
| | - Camille Golfier
- Centre Hospitalier Lyon Sud - Service d'Hématologie Clinique, Lyon, France
| | - Alessandra Tucci
- Hematology Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Monica Bocchia
- U.O.C Ematologia, Azienda Ospedaliero-Universitaria Senese - Policlinico Santa Maria alle Scotte, Siena, Italy
| | - SooKyoung Kim
- Celltrion Healthcare Co. Ltd., Incheon, Republic of Korea
| | - Young Nam Lee
- Celltrion Healthcare Co. Ltd., Incheon, Republic of Korea
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica e Sperimentale, Università di Bologna, Bologna, Italy
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Yamagami J, Ujiie H, Aoyama Y, Ishii N, Tateishi C, Ishiko A, Ichijima T, Hagihara S, Hashimoto K, Amagai M. A multicenter, open-label, uncontrolled, single-arm phase 2 study of tirabrutinib, an oral Bruton's tyrosine kinase inhibitor, in pemphigus. J Dermatol Sci 2021; 103:135-142. [PMID: 34376340 DOI: 10.1016/j.jdermsci.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The treatment of pemphigus is based on systemic corticosteroid use and adjuvant therapies, but some patients are resistant to conventional therapy. Tirabrutinib is a highly selective oral Bruton's tyrosine kinase inhibitor that may be clinically effective in treating pemphigus by suppressing B-cell signaling. OBJECTIVE We investigated the efficacy and safety of tirabrutinib in patients with refractory pemphigus. METHODS This was a multicenter, open-label, single-arm phase 2 study of Japanese patients with refractory pemphigus receiving appropriate treatment with an oral corticosteroid and adjuvant therapies. Patients received postprandial oral tirabrutinib 80 mg once daily for 52 weeks. After 16 weeks of tirabrutinib treatment, the corticosteroid dose was tapered to ≤10 mg/day of prednisolone equivalent. RESULTS In total, 16 patients were evaluated (mean age, 52.5 years; 50 % male). The complete remission rate after 24 weeks of treatment (primary endpoint) was 18.8 % (3/16; 95 % confidence interval, 6.6 %-43.0 %). By Week 52, eight patients (50.0 %) achieved complete remission and 10 patients (62.5 %) achieved remission. Over 52 weeks of treatment, the mean prednisolone dose decreased from 17.03 to 7.65 mg/day. Incidences of adverse events (AEs) and adverse drug reactions were 87.5 % and 43.8 %, respectively. A relationship with tirabrutinib was ruled out for all serious AEs and Grade ≥3 AEs. CONCLUSION Treatment with tirabrutinib enabled remission and reduced oral corticosteroid exposure over time and did not result in any major safety concerns in patients with refractory pemphigus. Thus, oral tirabrutinib may be a new treatment option for patients with refractory pemphigus.
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Affiliation(s)
- Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, Okayama, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Chiharu Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akira Ishiko
- Department of Dermatology, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Tomoki Ichijima
- Clinical Development Planning, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Shunsuke Hagihara
- Department of Statistical Analysis, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Koji Hashimoto
- Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
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Bermel RA, Waubant E, Pardo G, Bass A, Repovic P, Newsome S, Lindsey JW, Kile D, Pradhan A, Musch B, Zabeti A. Safety evaluation of shorter infusion for ocrelizumab in a substudy of the Phase IIIb CHORDS trial. Ann Clin Transl Neurol 2021; 8:711-715. [PMID: 33621404 PMCID: PMC7951110 DOI: 10.1002/acn3.51310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 11/24/2022] Open
Abstract
The CHORDS trial evaluated ocrelizumab (OCR) in patients with relapsing‐remitting multiple sclerosis who had a suboptimal response to previous disease‐modifying treatment. The objective of the present study was to assess the safety of shorter OCR infusions in a substudy of CHORDS. After completing four doses of OCR per initial US prescribing recommendations in the main study, participants in the substudy (N = 129) received a fifth dose over a 2‐h duration (vs. 3.5 h). Infusion‐related reactions occurred in 12.4% of patients. None were severe, life‐threatening or led to treatment discontinuation. Shorter infusion time did not change the safety profile of OCR. Clinicaltrials.gov (NCT0237856).
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Affiliation(s)
- Robert A Bermel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Gabriel Pardo
- Multiple Sclerosis Center of Excellence, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Ann Bass
- Neurology Center of San Antonio, San Antonio, TX, USA
| | | | - Scott Newsome
- Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John W Lindsey
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Deidre Kile
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Bruno Musch
- Genentech, Inc., South San Francisco, CA, USA
| | - Aram Zabeti
- UC Waddell Center for Multiple Sclerosis, Cincinnati, OH, USA
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Vollmer TL, Cohen JA, Alvarez E, Nair KV, Boster A, Katz J, Pardo G, Pei J, Raut P, Merchant S, MacLean E, Pradhan A, Moss B. Safety results of administering ocrelizumab per a shorter infusion protocol in patients with primary progressive and relapsing multiple sclerosis. Mult Scler Relat Disord 2020; 46:102454. [DOI: 10.1016/j.msard.2020.102454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
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Hanna KS, Segal EM, Barlow A, Barlow B. Clinical strategies for optimizing infusion center care through a pandemic. J Oncol Pharm Pract 2020; 27:165-179. [PMID: 32972300 DOI: 10.1177/1078155220960211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The national pandemic resulting from the novel coronavirus, COVID-19, has made the delivery of care for patients with cancer a challenge. There are competing risks of mortality from cancer versus serious complications and higher risk of death from COVID-19 in immunocompromised hosts. Furthermore, compounding these concerns is the inadequate supply of personal protective equipment, decreased hospital capacity, and paucity of effective treatments or vaccines to date for COVID-19. Guidance measures and recommendations have been published by national organizations aiming to facilitate the delivery of care in a safe and effective manner, many of which, are permanently adoptable interventions. Given the critical importance to continue chemotherapy, there remains additional interventions to further enhance patient safety while conserving healthcare resources such as adjustments in medication administration, reduction in laboratory or drug monitoring, and home delivery of specialty infusions. In this manuscript, we outline how to implement these actionable interventions of chemotherapy and supportive care delivery to further enhance the current precautionary measures while maintaining safe and effective patient care. Coupled with current published standards, these strategies can help alleviate the numerous challenges associated with this pandemic.
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Affiliation(s)
- Kirollos S Hanna
- Mayo Clinic College of Medicine, Rochester, USA
- M Health Fairview, Maple Grove, USA
| | - Eve M Segal
- Seattle Cancer Care Alliance, University of Washington Medical Center, Seattle, USA
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Shorter infusion time of ocrelizumab: Results from the randomized, double-blind ENSEMBLE PLUS substudy in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2020; 46:102492. [PMID: 33039944 PMCID: PMC7513877 DOI: 10.1016/j.msard.2020.102492] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ocrelizumab is an approved intravenously administered anti-CD20 antibody for multiple sclerosis (MS). Shortening the 600 mg infusion to 2 hours reduces the total site stay from 5.5-6 hours (approved infusion duration including mandatory pre-medication and post-infusion observation) to 4 hours. The safety profile of shorter-duration ocrelizumab infusions was investigated using results from ENSEMBLE PLUS. METHODS ENSEMBLE PLUS is a randomized, double-blind substudy to the single-arm ENSEMBLE study (NCT03085810). In ENSEMBLE, patients with early-stage relapsing-remitting MS received ocrelizumab 600 mg infusions every 24 weeks for 192 weeks. In ENSEMBLE PLUS, ocrelizumab 600 mg administered over the approved 3.5-hour infusion time (conventional duration) is compared with a 2-hour infusion (shorter duration); the durations of the initial infusions (2×300 mg, 14 days apart) were unaffected. The primary endpoint was the proportion of patients with infusion-related reactions (IRRs) following the first Randomized Dose. RESULTS From November 1, 2018, to December 13, 2019, 745 patients were randomized 1:1 to the conventional or shorter infusion group. At the first Randomized Dose, 99/373 patients (26.5%) in the conventional and 107/372 patients (28.8%) in the shorter infusion group experienced IRRs. The majority of IRRs were mild or moderate; >99% of all IRRs resolved without sequelae in both groups (conventional infusion group, 99/99; shorter infusion group, 106/107). No IRRs were serious, life-threatening, or fatal. No IRR-related discontinuations occurred. During the first Randomized Dose, 22/373 (5.9%) and 39/372 (10.5%) patients in the conventional and shorter infusion groups, respectively, had IRRs leading to infusion slowing/interruption. Adverse events were consistent with the known safety profile of ocrelizumab. CONCLUSION The rates and severity of IRRs were similar between conventional and shorter infusions. No new safety signals were detected. Shortening the infusion time to 2 hours reduces the total site stay time (including mandatory pre-medication/infusion/observation) from 5.5-6 hours to 4 hours, and may reduce patient and site staff burden. A short video summarizing the key results is provided in supplemental material.
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Hartung HP. Ocrelizumab shorter infusion: Primary results from the ENSEMBLE PLUS substudy in patients with MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/5/e807. [PMID: 32503093 PMCID: PMC7286651 DOI: 10.1212/nxi.0000000000000807] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the safety of ocrelizumab (OCR) shorter duration infusion in patients with MS. METHODS ENSEMBLE PLUS is a randomized, double-blind substudy to the single-arm ENSEMBLE study (NCT03085810). In ENSEMBLE, patients with early stage relapsing-remitting MS received OCR 600 mg initially as two 300 mg IV infusions 2 weeks apart and subsequently as a single 3.5-hour 600 mg infusion every 24 weeks for 192 weeks. In ENSEMBLE PLUS, OCR 600 mg administered over the approved 3.5-hour infusion time (conventional duration) is compared with a 2-hour infusion (shorter duration). The primary end point was the proportion of patients with infusion-related reactions (IRRs) after the first randomized dose (assessed during and up to 24 hours postinfusion). RESULTS From November 1, 2018, to September 27, 2019, 580 patients were randomized 1:1 to the conventional or shorter infusion group. After the first randomized dose, 67 of 291 patients (23.1%) in the conventional and 71 of 289 patients (24.6%) in the shorter infusion group experienced IRRs. Most IRRs were mild or moderate in both groups; one patient in each group experienced a severe IRR, and in both groups, 98.6% (136 of 138) of all IRRs resolved without sequelae. No IRRs were serious, life-threatening, or fatal. No IRR-related discontinuation occurred. During the first randomized dose, 14 of 291 (4.8%) and 25 of 289 (8.7%) patients in the conventional and shorter infusion groups, respectively, had IRRs leading to infusion slowing/interruption. CONCLUSION The frequency and severity of IRRs were similar between conventional and shorter OCR infusions. Shortening the infusion time to 2 hours reduces the total infusion site stay time and lessens the overall patient and site staff burden. CLASSIFICATION OF EVIDENCE This interventional study provides Class I evidence that the frequency and severity of IRRs were similar at the first randomized dose using OCR (600 mg) infusions of conventional and shorter duration in patients with relapsing-remitting MS. CLINICAL TRIAL IDENTIFIER NUMBER NCT03085810.
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Affiliation(s)
- Hans-Peter Hartung
- From the Department of Neurology, UKD, Center of Neurology and Neuropsychiatry and LVR-Klinikum, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany.
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Gaffney KJ, Dahl EM, Stanton MP, Starek E, Zembillas AS. Rapid-Infusion Rituximab in a Pediatric Population. J Pediatr Pharmacol Ther 2020; 25:215-219. [DOI: 10.5863/1551-6776-25.3.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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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Bernhardt MB, De Guzman MM, Grimes A, Kirk S, Nelson S, Bergsbaken J, Minard CG, Despotovic JM. Rapid infusion of rituximab is well tolerated in children with hematologic, oncologic, and rheumatologic disorders. Pediatr Blood Cancer 2018; 65. [PMID: 28792663 DOI: 10.1002/pbc.26759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 01/19/2023]
Abstract
Traditional administration of rituximab requires careful titration and may involve many hours to minimize the risk of reactions. The objective of this study was to evaluate the safety of rapid infusions of rituximab in a pilot group of children with hematologic, oncologic, and rheumatologic disorders, and to determine the incidence of rate-related infusion reactions. Twenty patients enrolled in the study. All patients tolerated the rapid infusion of rituximab and no patient had an infusion-related reaction. We conclude that rapid infusions of rituximab are well tolerated and safe in our pilot group of patients.
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Affiliation(s)
| | - Marietta M De Guzman
- Section of Immunology, Allergy, Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Amanda Grimes
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Center, Houston, Texas
| | - Susan Kirk
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Center, Houston, Texas
| | - Sheryl Nelson
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Jenny McDade Despotovic
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Center, Houston, Texas
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Dotson E, Crawford B, Phillips G, Jones J. Sixty-minute infusion rituximab protocol allows for safe and efficient workflow. Support Care Cancer 2015; 24:1125-9. [PMID: 26268782 DOI: 10.1007/s00520-015-2869-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/27/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Rituximab is a chimeric monoclonal antibody approved to treat B cell non-Hodgkin's lymphoma (NHL). Infusion reactions among NHL patients are common during the first exposure but decrease with subsequent infusions. We sought to assess the safety and feasibility of a rituximab rapid infusion protocol in the outpatient treatment area of a comprehensive cancer center. PATIENTS AND METHODS Patients with indolent and intermediate B cell NHL were invited to enroll in this prospective, single-institution study if they had received the first dose of rituximab according to the manufacturer-labeled standard titration schedule without grade >2 infusion reaction. The subsequent infusion proceeded without the use of steroid premedication at 100 mg/h administered over 15 min, with the remaining dose given over 45 min. Time savings between rapid infusion and standard titration were calculated. RESULTS Fifty patients received 60-min rituximab infusions during the second drug administration. No infusion-related reactions of any grade were observed with the rapid infusion protocol (0%, one-sided 97.5% CI 0-7.1%). The mean time for the rapid rituximab infusion was 62.4 min (95% CI 61.2-63.6). When compared to the standard second dose infusion recommendation, a mean time of 94.2 min (95% 90-98.4) was saved with rapid infusion. Nursing surveys demonstrated 100% satisfaction with the rapid infusion protocol. CONCLUSIONS Subsequent rituximab infusions can be safely administered over 60 min and without steroid premedication in an experienced outpatient infusion center when patients are appropriately screened. The faster infusions can reduce resource utilization and increase nursing satisfaction. TRIAL REGISTRATION NCT01206777.
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Affiliation(s)
- Emily Dotson
- The Ohio State Comprehensive Cancer Center-James Cancer Hospital, 460 W. 10th Ave., Columbus, OH, 43210, USA.
| | - Brooke Crawford
- Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Gary Phillips
- The Ohio State University Center for Biostatistics, Columbus, OH, USA
| | - Jeffrey Jones
- Department of Internal Medicine, Division of Hematology, The Ohio State Comprehensive Cancer Center-James Cancer Hospital, Columbus, OH, USA
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Wallace G, Myers KC, Davies SM, Teusink A, Jodele S. Rapid rituximab infusion is safe in paediatric and young adult patients with non-malignant indications. Br J Haematol 2015. [PMID: 26205134 DOI: 10.1111/bjh.13604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Gregory Wallace
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley Teusink
- Department of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Zhao W, Gao Y, Bai B, Cai QC, Wang XX, Cai QQ, Huang HQ. Safety and efficacy of non-initial rapid infusion of rituximab plus chemotherapy in Chinese patients with CD20+ non-Hodgkin's lymphoma. Expert Opin Drug Saf 2014; 14:21-9. [PMID: 25412839 DOI: 10.1517/14740338.2015.988138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of rapid rituximab infusion (RRI) plus chemotherapy in patients with CD20(+) non-Hodgkin's lymphoma (NHL). RESEARCH DESIGN AND METHODS A total of 177 patients received 4 - 6 cycles of rituximab-based chemotherapy. The first cycle was given with standard schedule. In the second and subsequent cycles, RRI was initiated. Rituximab was administered as 20% of the dose infused in the first 30 min and the remaining 80% was given over 60 min. Benadryl and dexamethasone were given before infusions. Vital signs were measured at baseline and during infusion. RESULTS In the first cycle, 48 patients experienced grade I - II infusion reactions and two patients showed grade III - IV infusion reactions. Six patients experienced infusion reactions during RRI. Two patients showed grade III infusion reactions to RRI and dropped out of the study. With a median follow up of 37.5 months, the 3-year overall survival and progression-free survival rates of the whole cohort were 93.1 and 81.1%, respectively. CONCLUSIONS Our preliminary observations suggested that RRI may be safe and feasible for patients with CD20(+) NHL.
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Affiliation(s)
- Wei Zhao
- Sun Yat-sen University, Cancer Center, State Key Laboratory of Oncology in Southern China, Department of Medical Oncology , Guangzhou , PR China +86 20 8734 3349 ; +86 20 8734 3350 ;
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Thirty-minutes infusion rate is safe enough for bevacizumab; no need for initial prolong infusion. Med Oncol 2014; 31:276. [PMID: 25294426 DOI: 10.1007/s12032-014-0276-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
Bevacizumab (Bev) is a vascular endothelial growth factor-A monoclonal antibody that targets tumor angiogenesis. The transfusion rate of Bev is 90 min in the first dose, 60 min in the second and than from the third dose it is 30 min if no hypersensitivity reaction occurs in the first two doses. The purpose of this study determines whether these initial prolonged infusions are really necessary or not. Between 2007 and 2009, we were using the standard schedule for Bev infusions. In July 2009, we reviewed our medical reports, nursing orders and adverse drug reaction forms to identify the Bev used patients and possible hypersensitivity reactions (HSRs). Depending on that information between August 2009 and July 2014, we started to make Bev infusions in 30 min from the first dose of the therapy. In this study, we documented the findings of these 30-min infusion used patients. From August 2009 to July 2014, we treated 145 patients with 1,145 Bev infusions each one in 30 min. Out of 145 patients, 12 of them received only single dosage of Bev infusion treatment. Bev doses were 5 mg/kg for 87 patients, 7.5 mg/kg for 64 patients, 10 mg/kg for four patients and 15 mg/kg for only one patient. No HSRs were reported during these transfusions. Initial prolonged infusion times are unnecessary for Bev. Thirty-minute infusion rates can be used safely for all courses.
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Frankfurt O, Ma S, Gordon L, Winter JN, Horowitz JM, Rademaker A, Weitner BB, Peterson LC, Altman JK, Tallman MS, Petrich A, Rosen ST. Phase II study of alemtuzumab-rituximab therapy in previously untreated patients with chronic lymphocytic leukemia: short- and long-term outcomes. Leuk Lymphoma 2014; 56:315-23. [PMID: 24707943 DOI: 10.3109/10428194.2014.910654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated the safety, efficacy, and long-term outcomes of alemtuzumab and rituximab (AR) combination therapy in previously untreated patients with CLL. Thirty patients, ages 28-80 years, 47% older than 60 years, 90% Rai clinical stages II-IV, and 67% without favorable cytogenetics received AR. Based on the NCI-WG 1996 criteria, OR was 100%, with 60% CR. With CT scans OR was 70%, with 23% CR, 47% PR, and 30% SD. Sixty-seven percent of patients showed no evidence of MRD in the bone marrow by 6-color flow cytometry. Median PFS, TFS, and 5-year OS were 24.4, 50.7 months, and 80%, respectively. Grade 3/4 neutropenia and thrombocytopenia were reported in 30% and 7% of patients, respectively. CMV reactivation, asymptomatic in all but one patient, occurred in 8 patients. Immunotherapy with alemtuzumab and rituximab results in robust responses and long asymptomatic therapy-free intervals. It is well tolerated with infrequent, predictable, and easily managed complications.
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Affiliation(s)
- Olga Frankfurt
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center , Chicago, IL , USA
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Pritchard CH, Greenwald MW, Kremer JM, Gaylis NB, Rigby W, Zlotnick S, Chung C, Jaber B, Reiss W. Safety of infusing rituximab at a more rapid rate in patients with rheumatoid arthritis: results from the RATE-RA study. BMC Musculoskelet Disord 2014; 15:177. [PMID: 24884454 PMCID: PMC4035685 DOI: 10.1186/1471-2474-15-177] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/16/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND As recommended in the current prescribing information, rituximab infusions in patients with rheumatoid arthritis (RA) take 4.25 hours for the first infusion and 3.25 hours for subsequent infusions, which is a burden on patients and the health care system. We therefore evaluated the safety of infusing rituximab at a faster rate for an infusion period of 2 hours in patients with RA. METHODS Patients with an inadequate response to anti-TNF who were rituximab-naive or -experienced received 2 courses of rituximab: Infusion 1 (Day 1) was administered over the standard 4.25 hours, and Infusions 2 (Day 15), 3 (Day 168) and 4 (Day 182) were administered over a faster 2-hour period. The primary endpoint was incidence of infusion-related reactions (IRRs) associated with Infusion 2. RESULTS Of the 351 patients enrolled, 87% and 13% were rituximab-naive and -experienced, respectively. The incidence (95% CI) of IRRs associated with Infusion 1 was 16.2% (12.5%, 20.5%) and consistent with weighted historical incidence of 20.7% (19.4%, 22.1%). The incidence (95% CI) of IRRs associated with Infusions 2, 3, and 4 compared with respective weighted historical incidences at the standard infusion rate was 6.5% (4.1%, 9.7%) vs 8.1% (7.2%, 9.1%); 5.9% (3.5%, 9.3%) vs 11.5% (10.3%, 12.8%); and 0.7 (0.1%, 2.6%) vs 5.0% (4.2%, 6.0%), respectively. All IRRs were grade 1 or 2, except for 3 grade 3 IRRs associated with Infusion 1 and 2 grade 3 IRRs associated with Infusion 2. Four patients experienced a total of 5 grade 3 IRRs; 3 of these patients continued on to received subsequent infusions at the faster rate. There were no serious IRRs. CONCLUSION This study demonstrated that rituximab can be administered at the faster infusion rate at the second and subsequent infusions without increasing the rate or severity of IRRs.
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Affiliation(s)
- Charles H Pritchard
- Rheumatology Specialty Center, 2360 Maryland Road, Willow Grove, PA 19090, USA.
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Arredondo-Garza T, Majluf-Cruz A, Vela-Ojeda J, Mariscal-Ramírez I, Solis-Anaya L, Lopez-Gutiérrez JR, Guadarrama CH, Rico-Curiel E, Armenta-San Sebastián JA, Castañeda-Hernández G. Peri-infusional adverse reactions to rituximab in patients with non-Hodgkin's lymphoma. Arch Med Res 2013; 44:549-54. [PMID: 24120421 DOI: 10.1016/j.arcmed.2013.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 09/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Rituximab is effective in the treatment of B-cell lymphoid malignances and some autoimmune diseases. Most patients receiving the first infusion of rituximab experience symptoms that decrease with subsequent infusions. It is assumed that the first dose of rituximab should be infused slowly during a 6-h period and during 4-h periods subsequently. The aim of the study was to evaluate the frequency and severity of adverse reactions to rituximab in patients with non-Hodgkin's lymphoma. METHODS This was an intensive pharmacovigilance prospective, observational, open labeled, multicenter cohort study conducted in 12 hospitals. Adults requiring treatment with rituximab (375 mg/m(2) body surface area) alone or with chemotherapy were included. Adverse reactions were graded according to the National Cancer Institute scale, whereas causality was established using the Naranjo algorithm. Infusions were classified as fast (0-90 min) and slow (>91 min). Fast infusions were used to analyze the associated adverse reactions. RESULTS We included 550 adult patients. Total infusion episodes were 1,749 and 52 adverse reactions were reported in 22 patients (4%). Thirty-one of 52 adverse reactions occurred during the first infusion. The risk of adverse reactions was lower with the fast infusions (10/52 adverse reactions [19.23%]). All adverse effects were mild. Twenty-three adverse effects were possibly related to rituximab. CONCLUSIONS Rituximab can be infused at a fast rate without an increase in adverse reactions. Peri-infusional adverse reactions are similar to those described for other populations but the incidence rate is lower. Rituximab has a favorable safety profile in patients with non-Hodgkin's lymphoma.
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Atmar J. Review of the safety and feasibility of rapid infusion of rituximab. J Oncol Pract 2013; 6:91-3. [PMID: 20592783 DOI: 10.1200/jop.200001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2009] [Indexed: 11/20/2022] Open
Abstract
Added to standard chemotherapy, rituximab improved survival in patients with non-Hodgkin's lymphoma; added to fludarabine-based regimens, it improved response and survival in patients with chronic B-cell lymphocytic leukemia.
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Affiliation(s)
- Jill Atmar
- Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Infusion Rate Escalation Study of Rituximab in Patients with CD20+ B-Cell Lymphomas: A Single Institution Analysis in Japan. ISRN ONCOLOGY 2013; 2013:863909. [PMID: 23691364 PMCID: PMC3649348 DOI: 10.1155/2013/863909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/28/2013] [Indexed: 11/19/2022]
Abstract
Background. To determine the maximum tolerable infusion rate of rituximab, and investigate the safety and feasibility of rapid infusion of rituximab for patients with CD20 positive B-cell lymphomas (CD20+NHL). Patients and Methods. 18 patients with CD20+NHL were registered. This study had six cohorts of administration rate of rituximab. The median age was 56 years (range, 38–79), and five of 18 patients were male. Two patients (11%) with diffuse large B-cell lymphoma were receiving R-CHOP therapy, two (11%) with indolent lymphoma were receiving R-CVP therapy, and 14 (78%) with indolent lymphoma were receiving rituximab as maintenance therapy. Results. A total of 88 cycles of rituximab was administered. Rapid infusion of rituximab was well tolerated, with only one grade 3 leukocytepenia and one grade 4 neutropenia. Four patients (22%) developed grade 1 infusion-related toxicities at the first administration of rituximab. No patient with severe drug-related events was observed.
Conclusions. We determined that the maximum tolerable infusion rate of rituximab is 300 mL/h (under 700 mg/h), and confirmed that administration of over 60 minutes is safe and feasible. We recommend rapid administration of rituximab for practice setting in patients with CD20+NHL being treated with rituximab or rituximab-containing chemotherapy. (Clinical trial no. JFCR2009-1027).
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Hong J, Kim JY, Ahn HK, Lee SM, Sym SJ, Park J, Cho EK, Ahn JY, Park S, Lee SP, Shin DB, Lee JH. Bone marrow involvement is predictive of infusion-related reaction during rituximab administration in patients with B cell lymphoma. Support Care Cancer 2012; 21:1145-52. [PMID: 23111943 DOI: 10.1007/s00520-012-1639-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 10/16/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study is to evaluate risk factors for infusion-related reaction (IRR) following rituximab administration in patients with B cell non-Hodgkin lymphoma. METHODS A retrospective analysis was conducted of patients with newly diagnosed B cell lymphoma who have received rituximab-included immunochemotherapy with appropriate premedication and commonly used schedule of infusion rate. IRRs were graded by review of the patients' electronic medical record according to the Common Terminology Criteria for Adverse Events version 4.0. RESULTS One hundred and sixty-nine patients were included in the analysis and most of the patients (150; 88.8 %) had diffuse large B cell lymphoma (DLBCL). Thirty-six patients (21.3 %) had any grade of IRRs: 23 patients were grade (G) 1 (13.6 %), 13 had ≥G2 IRRs (7.7 %), and only 4 had ≥G3 IRRs (2.4 %). All except one patient had IRR during the first cycle and only two had repetitive IRR thereafter. Bone marrow (BM) involvement was the strongest risk factor for IRR in multivariable analysis (odds ratio 4.06, 95 % confidence interval 1.67-9.89; p = 0.002). A subgroup analysis confined to patients with DLBCL showed very similar results when compared with the entire population, and patients with DLBCL who had ≥G2 IRR showed shorter event-free and overall survival when compared to those who did not. CONCLUSIONS BM involvement is predictive of occurrence of IRR during rituximab administration in patients with B cell lymphoma. More intensive premedication and careful observation for IRR during rituximab administration are required for patients with B cell lymphoma who have BM involvement.
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Affiliation(s)
- Junshik Hong
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Gachon University School of Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
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Can M, Alibaz-Öner F, Yılmaz-Öner S, Atagündüz P, İnanç N, Direskeneli H. Accelerated infusion rates of rituximab are well tolerated and safe in rheumatology practice: a single-centre experience. Clin Rheumatol 2012; 32:87-90. [PMID: 23053686 DOI: 10.1007/s10067-012-2094-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 08/08/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
Abstract
Due to the possible risk of infusion reactions of rituximab (RTX), a slow infusion rate (total infusion time, 255 min) is suggested for rheumatological use. However, especially in oncology field, accelerated infusion of RTX is reported to be well tolerated and safe. The aim of our study was to evaluate whether accelerated infusion rates of RTX would similarly be safe and tolerable in rheumatoid arthritis (RA) patients and other off-label rheumatological indications. All patients treated with RTX for RA and other autoimmune diseases between May 2011 and January 2012 were recruited to the study. Each treatment course consisted of two RTX 1,000 mg infusions, 2 weeks apart. Total time of the infusion for the first cycle was 255 min. Second and subsequent infusions were administered over 120 min as follows: 0-30 min, 100 mg; 30-60 min, 200 mg; 60-90 min, 300 mg; and 90-120 min, 400 mg. The Clinical Trials Classification of Adverse Events (CTCAE) version 4.3 was used to categorise side effects. The study population comprised 68 patients [F/M, 59:9; mean age, 52.4 (10.6) years]: 60 with RA, 4 with systemic lupus erythematosus (SLE), 1 with non-Hodgkin's lymphoma with SLE and 3 with vasculitis. A total of 77 fast infusions were administered. Eleven patients (16.2 %) had taken a fast infusion at the first course. A total of nine patients experienced at least one AE. Seven patients had a reaction on the first infusion (infusion-related reaction (IRR)), two patients on the second infusion and one patient on both infusions. When graded from 1 to 5 according to CTCAE v. 4.3, grade 1 IRRs were observed in a total of seven patients and grade 2 IRR in three patients. In this study of fast infusions, adverse events after RTX were mostly mild and seem to be well tolerated. Faster rituximab infusion times seem to be safe and might be incorporated into routine practice.
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Affiliation(s)
- Meryem Can
- School of Medicine, Deparment of Rheumatology, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.
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Atay S, Barista I, Gundogdu F, Akgedik K, Arpaci A. Rapid-infusion rituximab in lymphoma treatment: 2-year experience in a single institution. J Oncol Pract 2012; 8:141-3. [PMID: 22942806 DOI: 10.1200/jop.2011.000319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Rituximab is a chimeric anti-CD20 monoclonal antibody. We aimed to explore the safety and tolerability of rapid infusion rituximab, (over 90 minutes) in patients with non-Hodgkin's lymphoma at Hacettepe University Department of Medical Oncology. PATIENTS AND METHODS Adult patients diagnosed with non-Hodgkin's lymphoma who were to receive rituximab were included in the study. The schedule of administration for cycle 1 was unaltered and delivered according to the product monograph. All subsequent cycles were administered over a total infusion time of 90 minutes (20% of the dose in the first 30 minutes, then the remaining 80% over 60 minutes, total dose delivered in 500 mL). All patients were observed for infusion-related reactions during the rituximab infusion, and vital signs were recorded every 15 minutes. RESULTS From July 2006 to December 2008, 75 patients with non-Hodgkin's lymphoma were treated with rituximab-based chemotherapy. A total of 372 infusions were administered. The majority of patients were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone, or rituximab only. The 90-minute rituximab infusion schedule was well tolerated, with no grade 3 or 4 infusion-related adverse events observed. CONCLUSION A rapid infusion rituximab over 90 minutes is well tolerated and safe when administered as the second and subsequent infusions in the course of therapy.
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Lang D, Prouse J, Barry F, Catherwood A, Chaplin K, Elliott L, Greco K, McGahey W, Nilsen J, Singhal N. Evaluation of the safety and feasibility of rapid rituximab infusion. Asia Pac J Clin Oncol 2012; 8:71-5. [DOI: 10.1111/j.1743-7563.2011.01487.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dora Lang
- The Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia.
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Lang DSP, Hagger C, Pearson A. Safety of rapid rituximab infusion in adult cancer patients: a systematic review. Int J Nurs Pract 2011; 17:357-69. [PMID: 21781215 DOI: 10.1111/j.1440-172x.2011.01950.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to critically appraise, synthesize and present the best available evidence related to the safety of rapid rituximab infusion in adult non-Hodgkin lymphoma and chronic lymphocytic leukaemia patients. Data are from published and unpublished studies from electronic databases, grey literature and reference lists. The studies that met the inclusion criteria were critically appraised by two independent reviewers for methodological validity using standardized critical appraisal instruments. Proportional meta-analysis based on DerSimonian-Laird weights using a random effects model was used for statistical pooling through Stats Direct. Heterogeneity is assessed using Cochran Q. When statistical pooling is not possible, the findings were presented in narrative summary. Rapid rituximab infusion is safe for non-Hodgkin lymphoma patients at a 90 min regimen. However, there is insufficient evidence to support rapid rituximab infusions for chronic lymphocytic leukaemia patients.
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Affiliation(s)
- Dora S P Lang
- Singapore National University Hospital Centre for Evidence Based Nursing, Singapore.
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Larsen JL, Jacobsen S. Rapid infusion with rituximab: short term safety in systemic autoimmune diseases. Rheumatol Int 2011; 33:529-33. [PMID: 22068354 DOI: 10.1007/s00296-011-2208-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
To describe the incidence, types and severity of adverse events, related to an accelerated regime of rituximab infusion in patients with various autoimmune diseases. Fifty-four patients with systemic autoimmune disease, to be treated with 1,000 mg of rituximab twice 2 weeks apart, participated. Pre-medication (oral prednisolone, anti-histamine and paracetamol) was administered 1-4 h before infusion start. The first infusion was administered over a period of 195 min. The second infusion over a period of 90 min. Any adverse events were classified using the Clinical Trials Classification of Adverse Events (CTCAE) v. 3.0. Ten patients (18.5%) experienced at least one infusion-related reaction (IRR) ever. The first infusion was associated with reactions in 4 CTCAE categories of which rhinitis were the most frequent. The CTCAE severity grading showed six patients (11.1%) had a grade 1 reaction. One patient (1.8%) had grade 2 events on both infusions and two patients (3.6%) had a grade 3 event on both infusions. RA patients more often had an infusion-related reaction (IRR) (9.2%) than the rest. The types of IRR were mostly of allergic or angio-oedematic nature. In practise, the rapid infusion was an easy to use regime and the second infusion is of time sparing significance to health professionals. No unexpected side effects were observed in relation to the accelerated regime.
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Affiliation(s)
- Janni Lisander Larsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Buch MH, Smolen JS, Betteridge N, Breedveld FC, Burmester G, Dörner T, Ferraccioli G, Gottenberg JE, Isaacs J, Kvien TK, Mariette X, Martin-Mola E, Pavelka K, Tak PP, van der Heijde D, van Vollenhoven RF, Emery P. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis. Ann Rheum Dis 2011; 70:909-20. [PMID: 21378402 PMCID: PMC3086093 DOI: 10.1136/ard.2010.144998] [Citation(s) in RCA: 299] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2011] [Indexed: 01/19/2023]
Abstract
BACKGROUND Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab in the treatment of RA. METHODS Preparation of this new document involved many international experts experienced in the treatment of RA. Following a meeting to agree upon the core agenda, a systematic literature review was undertaken to identify all relevant data. Data were then interrogated by a drafting committee, with subsequent review and discussion by a wider expert committee leading to the formulation of an updated consensus statement. These committees also included patients with RA. RESULTS The new statement covers wide-ranging issues including the use of rituximab in earlier RA and impact on structural progression, and aspects particularly pertinent to rituximab such as co-medication, optimal dosage regimens, repeat treatment cycles and how to manage non-response. Biological therapy following rituximab usage is also addressed, and safety concerns including appropriate screening for hepatitis, immunoglobulin levels and infection risk. This consensus statement will support clinicians and inform patients when using B-cell depletion in the management of RA, providing up-to-date information and highlighting areas for further research. CONCLUSION New therapeutic strategies and treatment options for RA, a chronic destructive and disabling disease, have expanded over recent years. These have been summarised in general strategic suggestions and specific management recommendations, emphasising the importance of expedient disease-modifying antirheumatic drug implementation and tight disease control. This consensus statement is in line with these fundamental principles of management.
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Affiliation(s)
- Maya H Buch
- Section of Musculoskeletal Diseases, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Josef S Smolen
- Department of Internal Medicine 3, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
- Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | | | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Humboldt University, Charite Hospital, Berlin, Germany
| | - Thomas Dörner
- Department of Rheumatology and Clinical Immunology, Humboldt University, Charite Hospital, Berlin, Germany
| | | | - Jacques-Eric Gottenberg
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - John Isaacs
- Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Xavier Mariette
- Institut Pour la Santé et la Recherche Médicale (INSERM) U 1012, Hôpital Bicêtre, Université Paris-Sud 11, Paris, France
| | | | - Karel Pavelka
- Institute of Rheumatology and Clinic of Rheumatology Charles University, Prague, Czech Republic
| | - Paul P Tak
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ronald F van Vollenhoven
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Paul Emery
- Section of Musculoskeletal Diseases, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Bryan J, Borthakur G. Role of rituximab in first-line treatment of chronic lymphocytic leukemia. Ther Clin Risk Manag 2010; 7:1-11. [PMID: 21339937 PMCID: PMC3039008 DOI: 10.2147/tcrm.s5855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Indexed: 02/01/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a biologically heterogeneous illness that primarily afflicts the elderly. For many decades, the initial therapy for most patients requiring treatment was limited to single-agent alkylator therapy. Within the last two decades, we have seen remarkable progress in understanding the biology of CLL and the development of more effective treatment strategies that have employed monoclonal antibodies, such as rituximab (anti-CD20). Furthermore, recognition of the synergy between fludarabine, cyclophosphamide, and rituximab (FCR) prompted investigators to explore the clinical activity of FCR in Phase II and III trials in patients with relapsed/refractory or previously untreated CLL. On the basis of these findings, the US Food and Drug Administration (FDA) recently approved rituximab in combination with fludarabine and cyclophosphamide for the treatment of patients with relapsed/refractory or previously untreated CD20-postive CLL. Recent data from a randomized Phase III trial has confirmed improved overall survival with FCR in patients with previously untreated CLL. However, FCR is not for everyone. More tolerable regimens using rituximab for the elderly and less fit patients are being pursued in clinical trials. Recent Phase II trials have explored potentially less myelosuppressive approaches by using lower doses of fludarabine and cyclophosphamide, replacing fludarabine with pentostatin, and combining rituximab with chlorambucil. Furthermore new biomarkers predictive of early disease progression have prompted investigators to explore the benefits of early treatment with rituximab combined with other agents. In addition to the proven utility of rituximab as a frontline agent for CLL, rituximab has a favorable toxicity profile both as a single agent and in combination with chemotherapy. The majority of adverse events are Grade 1 and 2 infusion-related reactions (fevers, chills, and rigors) and occur with the first dose of rituximab. The improved tolerability observed with second and subsequent infusions allows for shorter infusion times. Rituximab's proven activity and favorable toxicity profile has made it an ideal agent for expanding treatment options for patients with CLL, the majority of whom are elderly.
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Affiliation(s)
- Jeffrey Bryan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Swan JT, Murillo JR, Cox JE, Lamoth B, Baker KR. Assessment of safety regarding rapid rituximab infusion. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1548-5315(11)70426-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Rituximab, a chimeric monoclonal antibody that depletes B cells by binding to the CD20 cell-surface antigen, has been investigated extensively in autoimmune disorders. Following the encouraging results in immune thrombocytopenia (ITP), the use of this agent was explored in other autoimmune hematologic diseases, most notably autoimmune hemolytic anemia (AIHA) and thrombotic thrombocytopenic purpura (TTP), characterized by the presence of pathogenetic autoantibodies. Although randomized clinical trials are lacking, the cumulative data would suggest that rituximab has a beneficial role in their treatment. Response to B-cell-depleting therapy is actually associated with a significant decrease of circulating autoantibodies. However, several lines of evidence indicate that the T-cell compartment may also be modulated by these interventions. The doses and the duration of rituximab treatment in patients with autoimmune diseases are still unclear. The incidence of severe side effects is low but not insignificant. In particular, the risk of systemic infections and viral reactivation is a major concern.
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Chiang J, Chan A, Shih V, Hee SW, Tao M, Lim ST. A prospective study to evaluate the feasibility and economic benefits of rapid infusion rituximab at an Asian cancer center. Int J Hematol 2010; 91:826-30. [PMID: 20461562 DOI: 10.1007/s12185-010-0583-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/12/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
Rituximab (Mabthera) is currently approved for the treatment of multiple subtypes of CD20-expressing, B-cell, non-Hodgkin's lymphoma. This study aimed to investigate whether rapid infusion of rituximab over 90 min is feasible without compromising patient's safety, and to reduce resource utilization at a cancer center. This is a prospective and open label study. Lymphoma patients who have received one cycle of rituximab without experiencing grade 3 or 4 infusional reaction were eligible for the rapid infusion of rituximab. Rapid infusion rituximab is infused over 90 min, with 20% of the dose given over the first 30 min and the remaining 80% over 60 min. A total of 79 patients were recruited for this study with a total of 269 infusions administered. Sixty-nine patients (87.3%) received rituximab in combination with chemotherapy. Average number of rituximab infusions administered to patients was 3.4 cycles. Rapid rituximab infusion schedule was well tolerated without any grade 3/4 infusion-related adverse events observed. An average amount of time saved per patient was 10.2 h. Rapid infusion rituximab over 90 min was well tolerated by patients, and shortened infusions have resulted in substantial reduction of resource utilization.
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Affiliation(s)
- Joen Chiang
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
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