Table 3.
Adverse effects documented following rituximab use
| Author | Adverse effects | Concomitant immunosupressants |
|---|---|---|
| Albert [35] | 1× hypotension/bradycardia/fever; 1× serum sickness after 2nd dose, high HACA; 1× ?lupus cebritis, ?meningitis 8wks after RTX | None allowed 1 month prior to RTX; 100 mg MP before infusions to reduce risk infusion reaction |
| Galarza [39] | 4 patients had adverse effects | MP; CYC stopped in all; MMF continued in 6 patients |
| Gottenberg [53] | 2× neutropenia, 2× serum sickness | 2 patients AZA, 1 HCQ, 2 MP, 1 CIC, 1 CYC |
| Gillis [18] | 1× herpes zoster, 1× UTI | Steroids and existing (CYC, AZA, MMF) |
| Gunnarsson [37] | 1× UTI, 1× neutropenic fever, 1× herpes zoster, 1× photosensitive eruption | CYC with 1st and last RTX; prednisolone (tapered) |
| Hernandez [56] | 1× terminal renal failure and colitis | CYC, steroids + others “as necessary” |
| Lindholm [25] | 1× osteitis in the jaw (possibly present before RTX), 1× serum sickness after 3rd RTX, 1× neutropenia and pseudomonas sepsis 2 months after last RTX, 1 patient died of pulmonary infection 23 months after RTX, 1 patinet died of dilated cardiomyopathy 18 months after RTX | RTX added to regimen (CYC/MMF), maintained until remission |
| Looney [13] | 1 mild infusion reaction; 1× herpes zoster 3 weeks after rituximab | Excluded CYC patients, others allowed |
| Lu [24] | 1× serum sickness-like reaction (responded to steroids), 1× SLE-pericarditis–DIED (BCs repopulated), 1× pneumococcal pneumonia/sepsis, 1× hyponatraemia and seizure hrs after CYC, 1× ARDS after CYC–DIED | CYC 750 mg, MP 250 mg IVI to reduce risk infusion reaction |
| LUNAR [29] | overall incidence comparable between placebo and RTX; differences in rates of leukopenia (12.3% vs 4.2%), neutropenia (5.5% vs 1.4%) and hypotension (11% vs 4.2%) | MMF and corticosteroids; retreated at 6/12 with same |
| Melander [58] | 5 infections, 4 moderate neutropenias | 3 also got CYC |
| Merrill [30] | 37.9% of the RTX group and 36.4% of the placebo had adverse effects (RTX: 4× serum sickness, more neutropenia) | RTX added to existing regimen; steroids tapered down |
| Shahrir [40] | 2× anaphylaxis, both failed to have the study’s incorporated pre-medication | RTX and MP added to existing regimen |
| Smith [31] | Infusion reactions comon (resolved with hydrocortisone and antihistamine), 1× serum sickness after 3rd RTX dose (responded to MP), low rates of infection (2× pneumonia, 1× UTI, 1× abscess) | 500 mg CYC with 1st RTX infusion, added to existing regimen (AZA or MMF) |
| Tamimoto [19] | 1× infusion reaction; 5× bacterial infection; 1× candidiasis; 1 died renal failure from disease progression | All on prednisolone; 2 CIC; 1 CYC |
| Tanaka [34] | bacterial infections—1× pneumonia, 1× enteritis, 2× UTI, cyctitis, URTIs | Prednisolone only; others not allowed |
| Tokunaga [49] | 1 herpes zoster in patient with IgG drop | Prednisolone; 1 on CYC at outset, but stopped during study |
| Tokunaga [38] | pneumonia ×2, herpes zoster, infected ulcer | Variable pre-study, stopped during study; low-dose steroid throughout |
| Vigna-Perez [15] | 1 invasive histocytosis (died) | RTX added to regimen |