Journal of Pharmaceutics & Pharmacology

Research Article

Rituximab’s Efficacy in Patients With Hypersensitivity Reactions

Nishath S1, Priyank T2, Hrishi V2, Sriharsha SN3, Jesindha B4 and Goutham KJ2*

1Department of Pharmacy Practice, Hillside College of Pharmacy and Research Centre, Bangalore, Karnataka, India
2Department of Clinical Pharmacology, HealthCare Global Enterprises Limited, Bangalore, India
3Principal, Professor, and Research Director, Hillside College of Pharmacy and Research Centre, Bangalore, Karnataka, India
4Vice Principal, Hillside College of Pharmacy and Research Centre, Bangalore, Karnataka, India
Address for Correspondence: Goutham KJ, Department of Clinical Pharmacology, HealthCare Global Enterprises Limited, Bangalore, India; Phone: +91 8122250791; E-mail: gowtam.k90@gmail.com
Submission: 04 February 2023
Accepted: 13 March 2023
Published: 15 March 2023
Copyright: © 2023 Nishath S, Priyank T, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The B-cell antigen CD20 is expressed on normal B-cells and almost all B-cell lymphomas. This non-modulating agent provides an excellent target for antibody-directed therapeutic regimens. IDECC2B8 (rituximab) is a monoclonal antibody (mAb) directed against the B-cell-specific antigen CD20. The monoclonal antibody mediates complement and antibody-dependent cell-mediated cytotoxicity. As its usage has surged, there have been growing concerns about rituximab-related infusion reactions. Approximately 1/4th of the patients receiving first administration show infusion reactions, and most of the time they are re-challenged safely. Since recent studies have reported the presence of serum anti-rituximab antibodies in patients who develop hypersensitivity reactions, we are evaluating the pharmacodynamic response of rituximab in patients re-challenged with it.
Methods: Our study was at HCG, Bangalore, a tertiary care oncology center. The clinical records of lymphoma patients were taken from January 2021 to June 2021. We classified them based on inclusion and exclusion criteria. Patients who developed hypersensitivity were enrolled in Group 1, and those who did not in Group 2. Hypersensitivity was graded as per WAO-SAR criteria. Response assessment after three cycles of a rituximab-based regimen using radiological response: the overall response rate was evaluated and statistically interpreted.
Results: A total of 26 patients were included in the study. 11 patients had hypersensitivity reactions, of which 6 had local reactions, 2 had mild-to-moderate reactions, and 3 had severe reactions. One of these patients had an elevated eosinophil count prior to chemotherapy and an elevated level afterward. The overall response rate was 54.55% in patients with hypersensitivity reactions and 66.66% in patients without hypersensitivity reactions.
Conclusion: It has been established that Rituximab treatment increases the risk of an allergic reaction; our goal was to review the efficacy of Rituximab in patients who developed hypersensitivity reactions as well as the underlying mechanisms.