PREMEDICATION WITH MONTELUKAST AND RUPATADINE DECREASES INFUSION TIME, RATE AND SEVERITY OF REACTIONS AND OVERALL COST OF RITUXIMAB ADMINISTRATION
Author(s): ,
Rouslan Kotchetkov
Affiliations:
Oncology,Royal Victoria Regional Heath Centre,Barrie,Canada
,
Jesse McLean
Affiliations:
RVH Research Institute,Royal Victoria Regional Heath Centre,Barrie,Canada
,
Lauren Gerard
Affiliations:
Oncology,Royal Victoria Regional Heath Centre,Barrie,Canada
,
Derek Nay
Affiliations:
Oncology,Royal Victoria Regional Heath Centre,Barrie,Canada
Sean Hopkins
Affiliations:
Oncology,Cancercare Ontario,Toronto,Canada
EHA Library. Kotchetkov R. Jun 15, 2019; 267132; PS1515
Prof. Dr. Rouslan Kotchetkov
Prof. Dr. Rouslan Kotchetkov
Contributions
Abstract

Abstract: PS1515

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Rituximab is associated with frequent infusion reactions, which carry significant burden to both patients and health care practitioners. Standard pre-medications (SP) do not prevent reactions sufficiently. Montelukast (M) and Rupatadine (R) are used for treatment of urticarial, allergic rhinitis, and may impact Rituximab infusion

Aims
We assessed impact of addition of R, M and their combination (R+M) on Rituximab infusion/rate, rate/severity of reactions and administration cost

Methods
Adult patients with lymphoproliferative disorders treated at our cancer center between Jan 2018 to Jan 2019 were evaluated with Rituximab-containing regiments. Since the majority of reactions occur during the first infusion, our study was limited to the initial Rituximab treatment. Patients received either SP with diphenhydramine/acetaminophen and additional R, M or R+M combination. Comparative analysis of infusion time/rate, severity of infusion reactions, number of rescue medications and cost of Rituximab infusions among groups was performed using one-way ANOVA with Tukey post-hoc or chi-square. The study was approved by our institutional ethics board 

Results
Patients received either: 1) standard premedications (SP); 2) SP + Rupatadine (R) 10 mg; 3) SP + Montelukast (M) 10 mg; or 4) both (SP+R+M). Patient characteristics and therapy are shown in Table 1. Compared to SP, the R, M and R+M groups had greater improvement in Rituximab delivery. Mean infusion time was 305 [range 235-441] min. in SP, 254 [105-390] in M, 265 [193-350] in R and 238 [196-342] in R+M groups, (p = 0.0001). Infusion reactions occurred in 92% in SP vs. 38, 45, 31% in M, R and R+M groups (p = 0.0001). Median reaction grade was 2 in SP, 1 (M), 0 (R and R+M). Median number of rescue medications was 3 [0-10] in SP vs 0 [0-7] in M, R and R+M groups. Cost of rescue medications (US$) was 41 [0-63] (SP), 11 [0-50] (M), 17 [0-63] (R), 7 [0-58] (R+M) groups (p < 0.0001). Mean nursing cost (US$) per patient infusion was calculated as 269 [207-388] in SP vs 222 [92-343] (M), 233 [170-308] (R), 209 [174-301] (R+M) group.  Table 1. Patient characteristics and therapy

 

SP

Montelukast

Rupatadine

Monteleukast + Rupatadine

N(patients)

26

21

20

26

Age:mean[min, max]

67 [45-87]

73 [35-91]

65 [51-88]

72 [50-86]

Male(%)

46

71

75

81

Hx of allergy (%)

39

33

50

31

Disease: pts (%)

DLBCL

FL

CLL

Other iNHL

 

6 (23)

9 (31)

4 (16)

7 (27)

 

3 (14)

2 (10)

4 (19)

12 (57)

 

5 (20)

5 (20)

5 (20)

5 (20)

 

8 (31)

5 (19)

2 (8)

11 (42)

Advance stage/bulky(%)

65

76

85

70

Tx naive 

96

86

80

93

Chemotherapy regimen:

RCHOP

BR

FCR

Other

 

8 (31)

15 (58)

2 (8)

1 (4)

 

5 (24)

9 (43)

2 (10)

5 (24)

 

6 (30)

6 (30)

5 (25)

3 (15)

 

10 (39)

10 (39)

2 (8)

4 (14)

Rituximab dose (mg): Mean [min-max]

727 [600-1000]

750 [550-1000]

740 [550-950]

762 [550-1000]

RCHOP, Rituximab/Cyclophosphamide/Doxorubicin/ Oncovin/Prednisone; BR, Bendamustine/Rituximab; FCR, Fludarabine/Cyclophosphamide/Rituximab

Conclusion
Addition of R, M and particularly R+M combination significantly improved Rituximab delivery, decreased the rate and severity of infusion reactions, and lowered the cost of Rituximab administration

Session topic: 35. Quality of life, palliative & supportive care, ethics and health economics

Keyword(s): Lymphoid malignancy, Prophylaxis, Rituximab, Supportive care

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