OBJECTIVE: According to the manufacturer's documentation, rituximab (RTX) should be administered with slow infusion rates to prevent infusion-related adverse events (AEs). Nevertheless, slow infusions are time-consuming and uncomfortable for patients and medical staff. Therefore, faster infusion rates have been studied and proven safe and well tolerated in lymphomas and rheumatoid arthritis (RA). A small amount of data is available for rapid RTX infusions in non-RA autoimmune diseases. METHODS: Beginning in September 2015, all RTX-reated patients in our centre and willing to participate, were switched from slow RTX infusions (4.25 hours, given at least once to all patients) to fast infusions (2 hours). A total of 85 RTX 2-hour infusions was administered to 53 patients with autoimmune diseases with renal involvement and selected primary glomerulonephritides (26 ANCA-associated vasculitis, nine systemic lupus erythematodes, seven membranous nephropathy, five IgM nephropathy and six other autoimmune disease). Most of the patients received chronic corticosteroid therapy. The prednisone equivalent dose median (IQR) was 0.1 (0.0-0.2) mg/kg/day. RESULTS: Rapid RTX infusions were generally well tolerated. Only two infusion-related AEs were recorded: one Common Terminology Criteria for Adverse Events, grade 3, (lower back pain and hypotension followed by chills necessitating methylprednisolone and dipyrone administration) and one grade 1 (subjective intolerance). The AEs frequency does not differ from other studies with rapid RTX infusions in patients with lymphomas and RA. CONCLUSIONS: Our experience supported other published data and provides evidence concerning the safety of non-initial RTX 2-hour infusion which can be administered without raising the infusion-related AEs rate in patients with kidney-affecting autoimmune diseases and glomerulonephritides.

Department of Nephrology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Institute of Pharmacology Department of Clinical Pharmacology and Pharmacy 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Zobrazit více v PubMed

Dotan E, Aggarwal C, Smith MR. Impact of rituximab (rituxan) on the treatment of B-cell non-Hodgkin’s lymphoma. P T 2010;35:148–57. PubMed PMC

Gürcan HM, Keskin DB, Stern JN, et al. . A review of the current use of rituximab in autoimmune diseases. Int Immunopharmacol 2009;9:10–25. 10.1016/j.intimp.2008.10.004 PubMed DOI

Kimby E. Tolerability and safety of rituximab (MabThera). Cancer Treat Rev 2005;31:456–73. 10.1016/j.ctrv.2005.05.007 PubMed DOI

Roche_Registration_Limited. Mabthera (rituximab) package insert, 2008.

Atmar J. Review of the safety and feasibility of rapid infusion of rituximab. J Oncol Pract 2010;6:91–3. 10.1200/JOP.200001 PubMed DOI PMC

Vogel WH. Infusion reactions: diagnosis, assessment, and management. Clin J Oncol Nurs 2010;14:E10–21. 10.1188/10.CJON.E10-E21 PubMed DOI

Patel J, Ho M, Ho V, et al. . Rapid infusion rituximab for maintenance therapy: is it feasible? Leuk Res Treatment 2013;2013:1–4. 10.1155/2013/629283 PubMed DOI PMC

Pritchard CH, Greenwald MW, Kremer JM, et al. . 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 10.1186/1471-2474-15-177 PubMed DOI PMC

Larsen JL, Jacobsen S. Rapid infusion with rituximab: short term safety in systemic autoimmune diseases. Rheumatol Int 2013;33:529–33. 10.1007/s00296-011-2208-0 PubMed DOI

Swan JT, Zaghloul HA, Cox JE, et al. . Use of a pharmacy protocol to convert standard rituximab infusions to rapid infusion shortens outpatient infusion clinic visits. Pharmacotherapy 2014;34:686–94. 10.1002/phar.1420 PubMed DOI

Can M, Alibaz-Öner F, Yılmaz-Öner S, et al. . Accelerated infusion rates of rituximab are well tolerated and safe in rheumatology practice: a single-centre experience. Clin Rheumatol 2013;32:87–90. 10.1007/s10067-012-2094-1 PubMed DOI

Conti F, Ceccarelli F, Perricone C, et al. . Rituximab infusion-related adverse event rates are lower in patients with systemic lupus erythematosus than in those with rheumatoid arthritis. Rheumatology 2011;50:1148–52. 10.1093/rheumatology/keq436 PubMed DOI

Sène D, Ghillani-Dalbin P, Amoura Z, et al. . Rituximab may form a complex with IgMkappa mixed cryoglobulin and induce severe systemic reactions in patients with hepatitis C virus-induced vasculitis. Arthritis Rheum 2009;60:3848–55. 10.1002/art.25000 PubMed DOI

Implications of rituximab pharmacokinetic and pharmacodynamic alterations in various immune-mediated glomerulopathies and potential anti-CD20 therapy alternatives