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Rituximab-induced serum sickness is more frequent in autoimmune diseases as compared to hematological malignancies: A French nationwide study
- Source :
- European Journal of Internal Medicine, European Journal of Internal Medicine, 2019, 67, pp.59-64. ⟨10.1016/j.ejim.2019.06.009⟩
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- International audience; INTRODUCTION: Rituximab induced serum sickness (RISS) is a rare delayed hypersensitivity reaction. The aim of this study was to describe the epidemiological and clinical characteristics of the RISS cases reported in France. METHOD: Serum sickness cases involving rituximab were identified from the French PharmacoVigilance Database from 1998 to 2016. RESULTS: We analyzed 37 cases of RISS. Rituximab was prescribed for an autoimmune disease in 78% of cases. Serum sickness occurred mainly after the first injection (54%) with a median time to onset of 12 days. The most frequent manifestations were rheumatologic symptoms (92%), fever (87%), and skin lesions (78%). The incidence was significantly higher when rituximab was used for autoimmune diseases than for a hematological malignancies. Taking into account the existence of a Systemic Lupus Erythematosus (SLE) as the indication of rituximab or as a comorbidity, the incidence of RISS in patients with SLE was even higher. DISCUSSION: We report on the largest series of RISS studied to date and confirm that this reaction preferentially occurs in patients with autoimmune disease, especially SLE. This may be due to B-cell lysis, leading to the release of intracellular antigens into the serum and subsequent antigen-antibody complex formation, especially in patients with elevated autoantibody production. This could also explain why RISS often occurred after a single injection. CONCLUSION: Patients generally recovered from RISS rapidly without obvious benefit from corticosteroid therapy. The risk of recurrence should prompt clinicians to question the use of rituximab after an episode of RISS.
- Subjects :
- Adult
Male
medicine.medical_specialty
[SDV]Life Sciences [q-bio]
Delayed reaction
030204 cardiovascular system & hematology
Adverse effect
Gastroenterology
Autoimmune Diseases
03 medical and health sciences
0302 clinical medicine
immune system diseases
Internal medicine
Epidemiology
Internal Medicine
Humans
Immunologic Factors
Medicine
Serum sickness
030212 general & internal medicine
Aged
Immune complexes
Autoimmune disease
business.industry
Incidence (epidemiology)
Middle Aged
medicine.disease
Comorbidity
3. Good health
Delayed hypersensitivity
Hematologic Neoplasms
Female
Rituximab
France
ArtClinique
business
medicine.drug
Subjects
Details
- ISSN :
- 09536205
- Volume :
- 67
- Database :
- OpenAIRE
- Journal :
- European Journal of Internal Medicine
- Accession number :
- edsair.doi.dedup.....cf1b158480810f57f96154c4e27f1d10