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Real-world Experience of Rituximab in Immune Thrombocytopenia

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Abstract

Immune thrombocytopenia (ITP) is a relapsing–remitting disease often requiring more than one line of therapy. Rituximab is a recommended second-line therapy, but the real-world data on its efficacy and safety from resource constraint settings is limited. We aimed to analyze the safety and efficacy of rituximab in ITP. This is a single-center, retrospective study. This study was conducted at a tertiary care hospital in Northern India from 2005 to 2019. On audit of medical records, all patients of ITP (n-513) who had received rituximab (n-81) were screened for inclusion. Patients whose response assessment was not possible were excluded. Finally, 66 patients were analyzed using statistical packages of Python v3.7. The cumulative incidence of overall response on day 20 was 30.61%, and day 30 was 51.72%. The median time to response was 28 day (range 21–51 day). Cumulative incidence of complete response was 16.67%, and partial response 37.88%. After a median follow-up of 789 day (range 181–5260 day), the cumulative incidence of relapse was 30.32%, 36.12%, and 56.57% at 1, 2, and 5 years respectively. There was no effect of age, sex, duration of disease, lines of therapy received, and platelet count on either cumulative incidence of overall response or relapse. ANA positivity was significantly related to the better cumulative incidence of overall response (p = 0.012), but not with relapse. Infusion-related reactions were the commonest adverse event noted (n-4, grade ≥ 3 CTCAEv4). Rituximab and its generic version are safe and effective second line agent in ITP with a good overall response and sustained response.

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This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral), New Delhi, 110010, India

    Kundan Mishra, Suman Kumar, Aditya Jandial, Kamal Kant Sahu, Rajeev Sandal, Yanamandra Uday, Rajiv Kumar, Rajan Kapoor, Tarun Verma, Sanjeevan Sharma, Jasjit Singh, Satyaranjan Das, Ajay Sharma & Velu Nair

  2. Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA

    Kamal Kant Sahu

  3. Department of Health and Family Welfare, Shimla, Himachal Pradesh, India

    Rajeev Sandal

  4. Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral), New Delhi, India

    Ankur Ahuja & Tathagat Chatterjee

  5. Department of Pediatrics, Army Hospital (Research & Referral), New Delhi, India

    Sanjeev Khera

  6. Department of Internal Medicine, INHS Asvini, Mumbai, India

    Rajiv Kumar

  7. Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, India

    Rajan Kapoor

  8. Department of Internal Medicine, Command Hospital (Central Command), Lucknow, India

    Sanjeevan Sharma

  9. Department of Internal Medicine, Command Hospital (Western Command), Chandimandir, India

    Jasjit Singh

  10. Department of Internal Medicine, Command Hospital (Southern Command), Pune, India

    Satyaranjan Das

  11. Department of Clinical Hematology and Stem Cell Transplant, Sir Ganga Ram Hospital, New Delhi, India

    Ajay Sharma

  12. Haemato-Oncology & Bone Marrow Transplant, Medical Services & Comprehensive Blood & Cancer Center (CBCC), Ahmedabad, India

    Velu Nair

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  1. Kundan Mishra
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Correspondence to Suman Kumar.

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Mishra, K., Kumar, S., Jandial, A. et al. Real-world Experience of Rituximab in Immune Thrombocytopenia. Indian J Hematol Blood Transfus 37, 404–413 (2021). https://doi.org/10.1007/s12288-020-01351-3

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