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Neutropenia may occur with Rituxan treatment for RA, autoimmune diseases
Rituxan was associated with late-onset neutropenia in some patients with rheumatoid arthritis and other autoimmune diseases, according to recently published details from a study.
A group of 2,624 patients with refractory autoimmune diseases, including 1,975 patients with rheumatoid arthritis (RA), who had at least one follow-up visit after initiating Rituxan (rituximab, Genentech) were included in the study. Patients were identified from the Autoimmunity and Rituximab (AIR) registry developed by the French Society of Rheumatology and the Club Rhumatismeet Inflammations, in which follow-up data are collected every 6 months for up to 7 years. Autoimmune diseases included systemic lupus erythematosus, various forms of vasculitis, granulomatosis with polyangiitis and others.
Eighty-five patients were reported to have neutropenia, but 45 were excluded due to preexisting neutropenia from other causes or resolution of neutropenia within 1 year. Of the 40 remaining patients, 25 had RA (1.3%) and 15 had other autoimmune diseases (2.3%). A median period of 4.5 months passed after the last infusion of rituximab until neutropenia was detected in patients with RA, compared with a median 5 months for patients with other diseases. Five of the patients with neutropenia, including one with RA, developed an opportunistic infection that required treatment with antibiotics and granulocyte colony-stimulating factor injection. All patients had favorable outcomes following treatment, according to the researchers.
Of 13 patients with neutropenia who stopped rituximab and later began retreatment, three had recurring neutropenia, but none were complicated with infection or required growth factors, the researchers reported.
“Late-onset neutropenia might occur after rituximab in patients with RA and other autoimmune diseases, but its incidence is much lower than in patients with blood malignancies,” the researchers wrote. “In addition, late-onset neutropenia is usually mild and might not be complicated with infections. Regarding clinical practice, it has been recommended to monitor whole blood count after each cycle of rituximab.” – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.