A Systematic Review of Case Reports/Case Series on Rituximab Rapid Desensitization
10.3870/j.issn.1004-0781.2024.08.014
- VernacularTitle:利妥昔单抗快速脱敏治疗病例报告/病例系列的系统评价
- Author:
Mo CHEN
1
;
Xue MA
;
Chao LI
;
Yue QIU
;
Ya CHEN
Author Information
1. 陆军军医大学(第三军医大学)军事预防医学系防原医学教研室,创伤、烧伤与复合伤国家重点实验室,重庆 400038
- Keywords:
Rituximab;
Drug hypersensitivity reactions;
Rapid drug desensitization
- From:
Herald of Medicine
2024;43(8):1259-1269
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the efficacy and safety of rituximab rapid desensitization therapy.Methods PubMed,Embase,Cochrane,Web of Science,Scopus,CNKI,Wanfang,and VIP databases were searched,and the search time frame was from the establishment of the database to February 2023.Two evaluators independently screened the literature,extracted data,and evaluated the quality of the included literature,and the resulting data were analyzed descriptively or statistically.The systematic review protocol was registered on PROSPERO(CRD:42022306557).Results Twenty-five studies(11 case reports and 14 case series)were included,with 138 patients desensitized,of whom 129 were successfully desensitized(i.e.,completed at least one target dose administration).The pretreatment regimen prior to desensitization was a combination of 2 or more of several classes of drugs,including H1 and H2 receptor antagonists,glucocorticoids,sedatives,NSAIDs,and acetaminophen,and 88%of the pretreatment regimens included H1 receptor antagonists or glucocorticoids.Sixteen studies(64.0%)reported on skin testing prior to desensitization,with positive rates of 12.50%for skin prick tests(n=16)and 49.15%for intradermal tests(n=59).Seventeen studies(68.0%)used the 3 bags-12 steps rapid desensitization protocol,the rest were for multiple desensitization methods such as 4 bags-16 steps or 2 bags-8 steps.The initial administration concentration of rituximab(i.e.,the concentration of the first desensitizing solution)was 1/10 X-1/10,000 X in most of the included studies,the first step infusion rate was 1.5-5 mL·min-1,and the total duration of single desensitization was approximately 4-10.5 h.Twenty-three studies(92%)reported the occurrence of anaphylactic reactions during patient desensitization,of which five studies had no anaphylactic reactions at the time of desensitization,and the majority of patients in the other 18 studies were able to continue to complete desensitization after being given symptomatic treatment or a modified desensitization regimen.Conclusions Current evidence suggests that rituximab rapid desensitization therapy has certain effectiveness and safety.However,there is still a lack of high-quality evidence or execution standards with strong operability and more large-sample,multicenter studies are needed to further explore the aspects of skin testing before desensitization,pretreatment,individualized desensitization steps,and management of allergic reactions during desensitization.
