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Experience with low‐dose rituximab in off‐label indications at two tertiary hospitals
Author(s) -
Chay J.,
Donovan P.,
Cummins L.,
Kubler P.,
Pillans P.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12207
Subject(s) - medicine , rituximab , tertiary care , family medicine , medical physics , lymphoma
Background Rituximab is a monoclonal antibody directed against B cells and is increasingly used to treat a variety of autoimmune conditions. Most published evidence reporting the successful use of rituximab in off‐label indications has empirically used a high‐dose regimen (either 375 mg/m 2 weekly for 4 weeks, or 1000 mg × 2), which is the approved course of treatment for lymphoma and rheumatoid arthritis patients. Aims The aims of this report are to review the indications, outcomes and adverse events of low‐dose (500 mg twice, given 1–2 weeks apart), off‐label use of rituximab in our institutions, and to review the available evidence. Methods We performed a retrospective audit of the off‐label use of low‐dose rituximab at two university teaching, tertiary referral hospitals, from mid‐2008 until the end of 2011. Results Off‐label rituximab was given to 52 patients (53 indications) across a heterogeneous group of autoimmune conditions. Outcomes were known for 46 conditions (affecting 45 patients), and of these, complete responses were observed in 16 (35%) conditions and a further 19 (41%) had a partial response. There was no response to rituximab in 11 (24%) patients. There were eight significant adverse events, mostly related to infectious complications. Conclusion This case series suggests that low‐dose courses of rituximab can be used off‐label to treat several severe and/or refractory immunological disorders with a reasonable safety profile; however, further trials are required in many off‐label indications.