Author Of 1 Presentation
P1076 - Effect of Rituximab on Immunoglobulin levels in Pediatric Multiple Sclerosis Patients (ID 911)
Abstract
Background
The efficacy of Rituximab as an off-label treatment for pediatric multiple sclerosis (MS) has been well-documented. The effects of Rituximab on immunoglobulin (Ig) levels have been documented in adult multiple sclerosis patients, but not in pediatric multiple sclerosis patients.
Objectives
In this study, we analyzed the relationship between pediatric Rituximab use for multiple sclerosis and Ig levels and the efficacy of interventions to manage Rituximab induced hypogammaglobulinemia.
Methods
In a retrospective chart review, we searched for pediatric multiple sclerosis patients who 1) used Rituximab as the sole disease modifying agent for MS 2) used Rituximab to only manage MS 3) had IgA, IgM and IgG measurements and 4) were <22 years old at dosing and Ig measurements.
Results
Thirty-four patients, 14 males and 20 females with a mean age of 16 years at time of initiation of Rituximab, had Ig measurements taken at least 40 days post Rituximab initiation. These Ig measurements were compared to baseline levels obtained from thirteen patients who had Ig levels within 40 days of the initial Rituximab dose, meeting baseline criteria. Rituximab dosing was 1000 mg per dose every 6.10 months on average. The average follow-up time between Ig measurements was 6.33 months. Of the 34 patients, 17 had Ig levels were within normal reference range after an average of 13.04 months of treatment. 17 patients had Ig levels below reference range after an average of 19.03 months of treatment. Patients with normal Ig values were on Rituximab therapy started on average at 16.35 years old, while patients with low Ig values started on average at 15.65 years old. All 17 had low IgM, 11 had only low IgM, 4 had low IgM and IgG, and 2 low IgM and IgA. 8 patients with low Ig levels did not receive an intervention, 5 had dose reduction to 750 mg, and 2 were subsequently reduced to 500 mg. The average follow-up Ig measurements in patients that had abnormal Ig measurements was every 5.26 months. The average time to initiate a lower Rituximab dose was 12.30 months. 2 of 5 patients who received a lower dose following a low Ig measurement had subsequent Ig measurements, and neither returned to reference range Ig levels.
Conclusions
In pediatric MS patients treated with Rituximab, 50% had low Ig levels. Neither of the 2 patients who were treated with lowered Rituximab dosing for low Ig and had follow-up Ig measurements returned to reference range Ig levels.
Presenter Of 1 Presentation
P1076 - Effect of Rituximab on Immunoglobulin levels in Pediatric Multiple Sclerosis Patients (ID 911)
Abstract
Background
The efficacy of Rituximab as an off-label treatment for pediatric multiple sclerosis (MS) has been well-documented. The effects of Rituximab on immunoglobulin (Ig) levels have been documented in adult multiple sclerosis patients, but not in pediatric multiple sclerosis patients.
Objectives
In this study, we analyzed the relationship between pediatric Rituximab use for multiple sclerosis and Ig levels and the efficacy of interventions to manage Rituximab induced hypogammaglobulinemia.
Methods
In a retrospective chart review, we searched for pediatric multiple sclerosis patients who 1) used Rituximab as the sole disease modifying agent for MS 2) used Rituximab to only manage MS 3) had IgA, IgM and IgG measurements and 4) were <22 years old at dosing and Ig measurements.
Results
Thirty-four patients, 14 males and 20 females with a mean age of 16 years at time of initiation of Rituximab, had Ig measurements taken at least 40 days post Rituximab initiation. These Ig measurements were compared to baseline levels obtained from thirteen patients who had Ig levels within 40 days of the initial Rituximab dose, meeting baseline criteria. Rituximab dosing was 1000 mg per dose every 6.10 months on average. The average follow-up time between Ig measurements was 6.33 months. Of the 34 patients, 17 had Ig levels were within normal reference range after an average of 13.04 months of treatment. 17 patients had Ig levels below reference range after an average of 19.03 months of treatment. Patients with normal Ig values were on Rituximab therapy started on average at 16.35 years old, while patients with low Ig values started on average at 15.65 years old. All 17 had low IgM, 11 had only low IgM, 4 had low IgM and IgG, and 2 low IgM and IgA. 8 patients with low Ig levels did not receive an intervention, 5 had dose reduction to 750 mg, and 2 were subsequently reduced to 500 mg. The average follow-up Ig measurements in patients that had abnormal Ig measurements was every 5.26 months. The average time to initiate a lower Rituximab dose was 12.30 months. 2 of 5 patients who received a lower dose following a low Ig measurement had subsequent Ig measurements, and neither returned to reference range Ig levels.
Conclusions
In pediatric MS patients treated with Rituximab, 50% had low Ig levels. Neither of the 2 patients who were treated with lowered Rituximab dosing for low Ig and had follow-up Ig measurements returned to reference range Ig levels.