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Tolerance and safety of rapid 2-hour infusion of rituximab in patients with kidney-affecting autoimmune diseases and glomerulonephritides: a single-centre experience
  1. Jan Miroslav Hartinger1,
  2. Veronika Satrapová2,
  3. Zdenka Hrušková2,
  4. Vladimír Tesař2
  1. 1Institute of Pharmacology, Department of Clinical Pharmacology and Pharmacy, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
  2. 2Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
  1. Correspondence to Jan Miroslav Hartinger, Farmakologický ústav, Univerzita Karlova v Praze 1 lekarska fakulta, Prague 12800, Czech Republic; hartinger.jan{at}vfn.cz

Abstract

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.

  • anca associated vasculitis
  • infusion related adverse events
  • membranous nephropathy
  • rituximab
  • rapid infusion

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