Hypersensitivity Reactions: Priming Practice Change to Reduce Incidence in First-Dose Rituximab Treatment.
Carissa Laudati, Caroline Clark, Andrea Knezevic and 2 others
PMID 30035788WHAT IT FOUND
Priming the IV line with rituximab rather than diluent was linked with fewer first-dose hypersensitivity reactions, but reactions appeared earlier and at lower infusion rates.
This occurred alongside rituximab titration, acetaminophen, diphenhydramine, and sometimes dexamethasone, hydrocortisone, or chemotherapy.
Key findings
01Drug-primed first-dose rituximab infusions had fewer HSRs than diluent-primed infusions (35% versus 19%; p=0.01).
02With drug priming, HSRs appeared earlier (median 86 minutes) and at a lower infusion rate (median 100 mg/hr) than with diluent priming.
03Dexamethasone premedication was associated with lower HSR odds (19.1% versus 36.7%; OR=0.41; p=0.005).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective chart review, not a randomised trial, so the lower reaction rate may reflect other changes between the two time periods. Data came from documentation, and some charts were excluded for incomplete documentation. The study was single-center, so its rituximab titration, premedication, and chemotherapy practices may not match other centers. Patients receiving chemotherapy were not excluded, and chemotherapy could reduce tumor burden and cytokine release. All reactions were grade 2, so the study does not show whether priming prevents severe reactions.
The easy way to misread this
Do not conclude that drug priming alone prevented more reactions. The study compared practice periods in one center, and patients also received rituximab titration, acetaminophen, diphenhydramine, and sometimes dexamethasone, hydrocortisone, or chemotherapy.