Infusion reactions to rituximab administration: algorithm of management

Abstract

Background. Allergic reactions to rituximab, which have been used for the past 20 years, are common in 32–62 % of patients. The purpose of the study: to develop an algorithm for controlling adverse reactions that occur during the introduction of rituximab. Materials and methods. The personal experience of treatment of 46 patients with various kidney diseases who received rituximab according to the indications according to the established diagnosis was analyzed. Evaluation of infusion allergic reactions was performed according to P.М. Kasi et al. (2012) for 5 classes of side effects. Results. It was found that allergic reactions to ritu­ximab occurred in 46 % of patients in the range from 1 to 4 classes. The probability of their occurrence according to the class was almost the same, but somewhat less documented for the 4th grade. Re-administration of diphenhydramine, methylprednisolone 125 mg or hydrocortisone 125 mg, if necessary salbutamol, oxygen allowed to eliminate most of the reaction, and then resumed the introduction of rituximab, starting from 25 mg/h, gradually increasing to 300 mg/h. This administration, performed 1–2 times, was effective in 1–3 classes of allergic reactions. For fourth grade, one patient required omalizumab. Generalized experience allowed to give a graphical and descriptive algorithm of actions in case of infusion side effects for rituximab. Conclusions. Based on special data and literature analysis, an algorithm for controlling infusion allergic reactions with intravenous rituximab was formulated.