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Rituximab study in pediatric autoimmune and inflammatory CNS disease

Discussion in 'Rituximab: News and Research' started by Nielk, Jul 9, 2014.

  1. Nielk

    Nielk

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    Queens, NY
    http://www.neurology.org/content/83/2/142

    Classification of evidence: This study provides Class IV evidence that in pediatric autoimmune and inflammatory CNS disorders, rituximab improves neurologic outcomes with a 7.6% risk of adverse infections.
     
    NK17, Valentijn, Sidereal and 2 others like this.
  2. Jonathan Edwards

    Jonathan Edwards Board Member

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    I have not seen the full paper, although I may be able to access it. I would just note two things. Firstly, neuropsychiatric lupus is a very severe condition with a high mortality, also very commonly associated with severe infection. Rituximab tends to be given in lupus when other treatments have failed and the patient is critically ill, particularly in children. So I am not quite sure what to make of the rate of complications. Lupus patients are also about the only people who have antibodies against rituximab before actually receiving the drug. Otherwise the severe infusion reactions sound atypical. The other point is that immunoglobulins behave quite differently in young children following rituximab. For both reasons I am not sure on the basis of the abstract that one should draw any conclusions from the side effects reported here for other contexts. The irony is that it does not necessarily make sense to restrict rituximab to those with significant morbidity and mortality - they are the ones most likely to get side effects. For those with more benign disease (in the sense of organ damage - I realise that ME is hardly 'benign' in other ways) rituximab seems much safer. I am not saying there are not occasional severe problems but I think the conclusion may give an unbalanced impression.
     
    Valentijn, NK17, rosie26 and 3 others like this.
  3. deleder2k

    deleder2k Senior Member

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    I would also suggest reading
    "Rituximab: how evidence based medicine can change
    our clinical practice" Leukemia & Lymphoma, July 2014; 55(7): 1694–1696.


    http://www.docdroid.net/elu9/104281942e20132e853302.pdf.html



    If someone wants to see "Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease", please send me a message.
     
    Last edited: Jul 11, 2014

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