SUCCESSFUL SWITCH FROM INTRAVENOUS TO SUBCUTANEOUS RITUXIMAB AT THE ULSTER HOSPITAL, BELFAST, NORTHERN IRELAND
(Abstract release date: 05/19/16)
EHA Library. Dillon R. 06/09/16; 134772; PB1872
Dr. Richard Dillon
Contributions
Contributions
Abstract
Abstract: PB1872
Type: Publication Only
Background
Chemo-Immunotherapy is currently widely used in treating lymphoproliferative disease. There is ever increasing indications for the monoclonal antibody, rituximab, with varied chemotherapy regimens. In our chemotherapy day unit there has been a significant increase in patients requiring chemo-immunotherapy. This increase has led to increasing waiting times for patients to start their chemotherapy. In 2005, a group at the Ulster Hospital completed a project examining the use of rapid intravenous (IV) rituximab infusion over 90 minutes as opposed to standard 4 ½ hours administration at this time, for continuing therapy as long as the first infusion had been tolerated without any reaction (El-Agnaf, et al., 2007). With the availability of subcutaneous (SC) rituximab, the group decided to switch to this product for patients with DLBCL and Follicular Lymphoma being treated with a combination of rituximab and chemotherapy.
Aims
Methods
We examined the notes of all patients who received subcutaneous Rituximab either in combination with CHOP, CVP or alone as maintenance treatment. The first dose of rituximab was given IV as per the product monograph. The second and subsequent doses for eligible patients were given over 5-6 minutes SC at a fixed dose of 1400 mg.All eligible patients received standard oral premedication of prednisolone, chlorphenamine and paracetamol.Patients were monitored closely and any adverse events recorded using National Cancer Institute (NCI) common terminology criteria for adverse events. Vital signs (Blood Pressure (BP), temperature, pulse, digital O2 saturation and respiratory rate) were checked before the first Rituximab infusion and 15 minutes after the infusion commenced. If normal at these time points, they were then checked 30 minutes later and at infusion end.For SC rituximab, vital signs were measured prior to first injection, and one hour post administration. If the patient had no adverse reaction to the first SC injection, subsequent SC therapy was given with vital signs monitored prior to injection only.A sample of patients were contacted by telephone and asked about their treatment preference. The nursing staff were also asked about their preference.
Results
There were no reported adverse reactions to the first infusion in all patients. SC rituximab was well tolerated apart from mild local skin reactions. None of these reactions requires specific therapy and did not preclude further SC treatments. The service change from IV to SC was smooth with no issues noted by staff involved. In total 29 patients (7DLBCL and 22 Follicular lymphoma) received 135 vials of 1400mg SC rituximab from 1st January 2015 until 31st December 2015.If all 29 patients had rapid IV infusion over 90mins, they would have taken 202hours 30mins (if each infusion went smoothly). Our SC rituximab patient sample took 37hours 30mins to infuse (allowing 10mins for injecting the SC rituximab and 1hour observation post 1st SC rituximab). This equated to a minimum saving of 165 nursing hours.Our pharmacy takes 31mins to manufacture IV rituximab as opposed to 7mins for SC rituximab. In 2015 we saved our pharmacy a minimum of 55hours.Patients uniformly preferred SC Rituximab over IV, as did the nursing staff.
Conclusion
A number of studies (Salar, et al., 2014) (Davies, et al., 2014) showed that there was non inferiority of SC rituximab (1400 mg) compared with IV rituximab (375 mg/m2) for treatment outcomes and that the only safety considerations relates to a higher incidence of administration related reactions.Overall response rate and complete response rate indicate that switching to SC rituximab has no effect on anti-lymphoma activity, but decreases overall administration time to 5-6 minutes without significantly affecting patient safety, and is acceptable to patients.Switching from IV to SC Rituximab has had a significant impact on the time spent for the patient in the unit, the time pharmacy saved in Rituximab preparation and storage of the product and the time saved by nursing staff administering the drug.
Session topic: E-poster
Keyword(s): DLBCL, Follicular lymphoma, Rituximab, Subcutaneous
Type: Publication Only
Background
Chemo-Immunotherapy is currently widely used in treating lymphoproliferative disease. There is ever increasing indications for the monoclonal antibody, rituximab, with varied chemotherapy regimens. In our chemotherapy day unit there has been a significant increase in patients requiring chemo-immunotherapy. This increase has led to increasing waiting times for patients to start their chemotherapy. In 2005, a group at the Ulster Hospital completed a project examining the use of rapid intravenous (IV) rituximab infusion over 90 minutes as opposed to standard 4 ½ hours administration at this time, for continuing therapy as long as the first infusion had been tolerated without any reaction (El-Agnaf, et al., 2007). With the availability of subcutaneous (SC) rituximab, the group decided to switch to this product for patients with DLBCL and Follicular Lymphoma being treated with a combination of rituximab and chemotherapy.
Aims
- Investigate the safety profile of SC Rituximab in treatment of DLBCL/Follicular lymphoma.
- Impact of SC Rituximab on the resource utilisation within our department.
- Convenience of adminstration of SC Rituximab for both patients and nursing staff.
Methods
We examined the notes of all patients who received subcutaneous Rituximab either in combination with CHOP, CVP or alone as maintenance treatment. The first dose of rituximab was given IV as per the product monograph. The second and subsequent doses for eligible patients were given over 5-6 minutes SC at a fixed dose of 1400 mg.All eligible patients received standard oral premedication of prednisolone, chlorphenamine and paracetamol.Patients were monitored closely and any adverse events recorded using National Cancer Institute (NCI) common terminology criteria for adverse events. Vital signs (Blood Pressure (BP), temperature, pulse, digital O2 saturation and respiratory rate) were checked before the first Rituximab infusion and 15 minutes after the infusion commenced. If normal at these time points, they were then checked 30 minutes later and at infusion end.For SC rituximab, vital signs were measured prior to first injection, and one hour post administration. If the patient had no adverse reaction to the first SC injection, subsequent SC therapy was given with vital signs monitored prior to injection only.A sample of patients were contacted by telephone and asked about their treatment preference. The nursing staff were also asked about their preference.
Results
There were no reported adverse reactions to the first infusion in all patients. SC rituximab was well tolerated apart from mild local skin reactions. None of these reactions requires specific therapy and did not preclude further SC treatments. The service change from IV to SC was smooth with no issues noted by staff involved. In total 29 patients (7DLBCL and 22 Follicular lymphoma) received 135 vials of 1400mg SC rituximab from 1st January 2015 until 31st December 2015.If all 29 patients had rapid IV infusion over 90mins, they would have taken 202hours 30mins (if each infusion went smoothly). Our SC rituximab patient sample took 37hours 30mins to infuse (allowing 10mins for injecting the SC rituximab and 1hour observation post 1st SC rituximab). This equated to a minimum saving of 165 nursing hours.Our pharmacy takes 31mins to manufacture IV rituximab as opposed to 7mins for SC rituximab. In 2015 we saved our pharmacy a minimum of 55hours.Patients uniformly preferred SC Rituximab over IV, as did the nursing staff.
Conclusion
A number of studies (Salar, et al., 2014) (Davies, et al., 2014) showed that there was non inferiority of SC rituximab (1400 mg) compared with IV rituximab (375 mg/m2) for treatment outcomes and that the only safety considerations relates to a higher incidence of administration related reactions.Overall response rate and complete response rate indicate that switching to SC rituximab has no effect on anti-lymphoma activity, but decreases overall administration time to 5-6 minutes without significantly affecting patient safety, and is acceptable to patients.Switching from IV to SC Rituximab has had a significant impact on the time spent for the patient in the unit, the time pharmacy saved in Rituximab preparation and storage of the product and the time saved by nursing staff administering the drug.
Session topic: E-poster
Keyword(s): DLBCL, Follicular lymphoma, Rituximab, Subcutaneous
Abstract: PB1872
Type: Publication Only
Background
Chemo-Immunotherapy is currently widely used in treating lymphoproliferative disease. There is ever increasing indications for the monoclonal antibody, rituximab, with varied chemotherapy regimens. In our chemotherapy day unit there has been a significant increase in patients requiring chemo-immunotherapy. This increase has led to increasing waiting times for patients to start their chemotherapy. In 2005, a group at the Ulster Hospital completed a project examining the use of rapid intravenous (IV) rituximab infusion over 90 minutes as opposed to standard 4 ½ hours administration at this time, for continuing therapy as long as the first infusion had been tolerated without any reaction (El-Agnaf, et al., 2007). With the availability of subcutaneous (SC) rituximab, the group decided to switch to this product for patients with DLBCL and Follicular Lymphoma being treated with a combination of rituximab and chemotherapy.
Aims
Methods
We examined the notes of all patients who received subcutaneous Rituximab either in combination with CHOP, CVP or alone as maintenance treatment. The first dose of rituximab was given IV as per the product monograph. The second and subsequent doses for eligible patients were given over 5-6 minutes SC at a fixed dose of 1400 mg.All eligible patients received standard oral premedication of prednisolone, chlorphenamine and paracetamol.Patients were monitored closely and any adverse events recorded using National Cancer Institute (NCI) common terminology criteria for adverse events. Vital signs (Blood Pressure (BP), temperature, pulse, digital O2 saturation and respiratory rate) were checked before the first Rituximab infusion and 15 minutes after the infusion commenced. If normal at these time points, they were then checked 30 minutes later and at infusion end.For SC rituximab, vital signs were measured prior to first injection, and one hour post administration. If the patient had no adverse reaction to the first SC injection, subsequent SC therapy was given with vital signs monitored prior to injection only.A sample of patients were contacted by telephone and asked about their treatment preference. The nursing staff were also asked about their preference.
Results
There were no reported adverse reactions to the first infusion in all patients. SC rituximab was well tolerated apart from mild local skin reactions. None of these reactions requires specific therapy and did not preclude further SC treatments. The service change from IV to SC was smooth with no issues noted by staff involved. In total 29 patients (7DLBCL and 22 Follicular lymphoma) received 135 vials of 1400mg SC rituximab from 1st January 2015 until 31st December 2015.If all 29 patients had rapid IV infusion over 90mins, they would have taken 202hours 30mins (if each infusion went smoothly). Our SC rituximab patient sample took 37hours 30mins to infuse (allowing 10mins for injecting the SC rituximab and 1hour observation post 1st SC rituximab). This equated to a minimum saving of 165 nursing hours.Our pharmacy takes 31mins to manufacture IV rituximab as opposed to 7mins for SC rituximab. In 2015 we saved our pharmacy a minimum of 55hours.Patients uniformly preferred SC Rituximab over IV, as did the nursing staff.
Conclusion
A number of studies (Salar, et al., 2014) (Davies, et al., 2014) showed that there was non inferiority of SC rituximab (1400 mg) compared with IV rituximab (375 mg/m2) for treatment outcomes and that the only safety considerations relates to a higher incidence of administration related reactions.Overall response rate and complete response rate indicate that switching to SC rituximab has no effect on anti-lymphoma activity, but decreases overall administration time to 5-6 minutes without significantly affecting patient safety, and is acceptable to patients.Switching from IV to SC Rituximab has had a significant impact on the time spent for the patient in the unit, the time pharmacy saved in Rituximab preparation and storage of the product and the time saved by nursing staff administering the drug.
Session topic: E-poster
Keyword(s): DLBCL, Follicular lymphoma, Rituximab, Subcutaneous
Type: Publication Only
Background
Chemo-Immunotherapy is currently widely used in treating lymphoproliferative disease. There is ever increasing indications for the monoclonal antibody, rituximab, with varied chemotherapy regimens. In our chemotherapy day unit there has been a significant increase in patients requiring chemo-immunotherapy. This increase has led to increasing waiting times for patients to start their chemotherapy. In 2005, a group at the Ulster Hospital completed a project examining the use of rapid intravenous (IV) rituximab infusion over 90 minutes as opposed to standard 4 ½ hours administration at this time, for continuing therapy as long as the first infusion had been tolerated without any reaction (El-Agnaf, et al., 2007). With the availability of subcutaneous (SC) rituximab, the group decided to switch to this product for patients with DLBCL and Follicular Lymphoma being treated with a combination of rituximab and chemotherapy.
Aims
- Investigate the safety profile of SC Rituximab in treatment of DLBCL/Follicular lymphoma.
- Impact of SC Rituximab on the resource utilisation within our department.
- Convenience of adminstration of SC Rituximab for both patients and nursing staff.
Methods
We examined the notes of all patients who received subcutaneous Rituximab either in combination with CHOP, CVP or alone as maintenance treatment. The first dose of rituximab was given IV as per the product monograph. The second and subsequent doses for eligible patients were given over 5-6 minutes SC at a fixed dose of 1400 mg.All eligible patients received standard oral premedication of prednisolone, chlorphenamine and paracetamol.Patients were monitored closely and any adverse events recorded using National Cancer Institute (NCI) common terminology criteria for adverse events. Vital signs (Blood Pressure (BP), temperature, pulse, digital O2 saturation and respiratory rate) were checked before the first Rituximab infusion and 15 minutes after the infusion commenced. If normal at these time points, they were then checked 30 minutes later and at infusion end.For SC rituximab, vital signs were measured prior to first injection, and one hour post administration. If the patient had no adverse reaction to the first SC injection, subsequent SC therapy was given with vital signs monitored prior to injection only.A sample of patients were contacted by telephone and asked about their treatment preference. The nursing staff were also asked about their preference.
Results
There were no reported adverse reactions to the first infusion in all patients. SC rituximab was well tolerated apart from mild local skin reactions. None of these reactions requires specific therapy and did not preclude further SC treatments. The service change from IV to SC was smooth with no issues noted by staff involved. In total 29 patients (7DLBCL and 22 Follicular lymphoma) received 135 vials of 1400mg SC rituximab from 1st January 2015 until 31st December 2015.If all 29 patients had rapid IV infusion over 90mins, they would have taken 202hours 30mins (if each infusion went smoothly). Our SC rituximab patient sample took 37hours 30mins to infuse (allowing 10mins for injecting the SC rituximab and 1hour observation post 1st SC rituximab). This equated to a minimum saving of 165 nursing hours.Our pharmacy takes 31mins to manufacture IV rituximab as opposed to 7mins for SC rituximab. In 2015 we saved our pharmacy a minimum of 55hours.Patients uniformly preferred SC Rituximab over IV, as did the nursing staff.
Conclusion
A number of studies (Salar, et al., 2014) (Davies, et al., 2014) showed that there was non inferiority of SC rituximab (1400 mg) compared with IV rituximab (375 mg/m2) for treatment outcomes and that the only safety considerations relates to a higher incidence of administration related reactions.Overall response rate and complete response rate indicate that switching to SC rituximab has no effect on anti-lymphoma activity, but decreases overall administration time to 5-6 minutes without significantly affecting patient safety, and is acceptable to patients.Switching from IV to SC Rituximab has had a significant impact on the time spent for the patient in the unit, the time pharmacy saved in Rituximab preparation and storage of the product and the time saved by nursing staff administering the drug.
Session topic: E-poster
Keyword(s): DLBCL, Follicular lymphoma, Rituximab, Subcutaneous
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