Pharmaceutical Care of Adverse Reactions Caused by Rituximab in the Treatment of Graves Orbitopathy

doi:10.19803/j.1672-8629.2021.12.19

Abstract

Abstract: Objective To analyze the characteristics of adverse reactions caused by rituximab in the treatment of Graves orbitopathy and recommend ways of prevention and treatment so as to provide reference for clinical safe drug use and for pharmaceutical care.Methods The clinical data on a total of 48 patients who used rituximab 99 times between June 1, 2018 and December 31, 2019 was analyzed retrospectively. Results ADRoccurred in 10 of the 48 cases, including 8 females (80.00%) and 2 males (20.00%) aged 25 to 54. The organs/systems involved were the respiratory system, cardiovascular system, the skin and subcutaneous tissues. ADR mostly occurred the first time rituximab was administered, but the symptoms were mild.Conclusion Clinical pharmacists should strengthen pharmaceutical care when adopting treatment schemes involving new drugs that are not often used and lack safety study. Related physiological indicators and mental state of patients deserve more attention and priorities of pharmaceutical care should be specified. Contraindications should be eliminated in time to ensure medication safety and prove the worth of clinical pharmacists.

Key words: Graves orbitopathy, rituximab, adverse drug reaction, pharmaceutical care

CLC Number:

R994.11

HE Xinyi, WANG Shaoke, XUE Xiaorong, HU Bin. Pharmaceutical Care of Adverse Reactions Caused by Rituximab in the Treatment of Graves Orbitopathy[J]. Chinese Journal of Pharmacovigilance, 2021, 18(12): 1186-1188.

References

[1] Hu ZR, Xu HY, Xu DD, et al.The immunotherapy of thyroid associated ophthalmopathy[J]. Medical Journal of Peking Union Medical College Hospital(协和医学杂志), 2015, 6(6): 462-466.
[2] Bartalena L, Baldeschi L, Boboridis K, et al.The 2016 european thyroid association/European group on Graves’orbitopathy guidelines for the management of Graves’orbitopathy[J]. Eur Thyroid J, 2016, 5(1): 9-26.
[3] Salvi M, Vannucchi G, Campi I, et al.Efficacy of rituximab treatment for thyroid-associated ophthalmopathy as a result of intraorbital B-cell depletion in one patient unresponsive to steroid immunosuppression[J]. Eur J Endocrinol, 2006, 154(4): 511-517.
[4] Zhu HG, Liao L, Dong JJ.Research progress of rituximab in treatment of thyroid associated ophthalmology[J]. Chinese Journal of Clinicians(Electronic Edition)(中华临床医师杂志电子版), 2016, 10(19): 2913-2916.
[5] Ye XZ, Wang J.Two cases of rituximab for treatment of Graves ophthalmopathy[J]. Jiangsu Medical Journal(江苏医药), 2010, 36(7): 863-864.
[6] Liu H, Zhang GM, Zhang YH.Clinical observation and analysis of 29 cases of adverse reactions of rituximab injection[J]. Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2011, 31(5): 429-431.
[7] Zhu H, Zhou F, Jin J.Literature anaIysis of 56 cases of adverse reactions induced by rituximab[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2018, 15(1): 52-56.
[8] Chen Y, Gao YY, Li Y, et al.Literature analysis of 325 cases of adverse drug reaction of rituximab[J]. Journal of Guangdong Pharmaceutical College(广东药学院学报), 2010, 26(2): 179-181.
[9] Descotes J.Immunotoxicity of monoclonal antibodies[J]. MAbs, 2009, 1(2): 104-111.
[10] Salvi M, Vannucchi G, Curro N, et al.Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves’orbitopathy: a randomized controlled study[J]. J Clin Endocrinol Metab, 2015, 100(2): 422-431.
[11] Salvi M, Vannucchi G, Beck-Peccoz P.Potential utility of rituximab for Graves’ orbitopathy[J]. J Clin Endocrinol Metab, 2013, 98(11): 4291-4299.
[12] van Vollenhoven RF, Emery P, Bingham CO, et al.Long-term safety of rituximab in rheumatoid arthritis: 9.5-year follow-up of the global clinical trial programme with a focus on adverse events of interest in RA patients[J]. Ann Rheum Dis, 2013, 72(9): 1496-1502.
[13] Salvi M, Vannucchi G, Curro N, et al.Small dose of rituximab for graves orbitopathy: new insights into the mechanism of action[J]. Arch Ophthalmol, 2012, 130(1): 122-124.
[14] Savino G, Balia L, Colucci D, et al.Intraorbital injection of rituximab: a new approach for active thyroid-associated orbitopathy, a prospe-ctive case series[J]. Minerva Endocrinol, 2013, 38(2): 173-179.
[15] Mitchell AL, Gan EH, Morris M, et al.The effect of B cell depletion therapy on anti-TSH receptor antibodies and clinical outcome in glucocorticoid-refractory Graves’orbitopathy[J]. Clin Endocrinol(Oxf), 2013, 79(3): 437-442.
[16] Xie Y, Zhu J, Zheng W, et al.Clinical observation on rituximab combined with chemotherapy in the treatment of diffused large B cell lymphonla[J]. Tumor(肿瘤), 2009, 29(1): 53-57.
[17] Tian H, Wang RF.The importance of rational control of infusion speed in clinical[J]. Lishizhen Medicine and Materia Medica Research(时珍国医国药), 2008(10): 2544-2545.
[18] Song XK.Influential factor of transfusion speed in administration and medication security[J]. Chinese Pharmaceutical Affairs(中国药事), 2007(7): 514-518.