Rituximab-induced serum sickness: A systematic review

Paras Karmacharya, Dilli Ram Poudel, Ranjan Pathak, Anthony A. Donato, Sushil Ghimire, Smith Giri, Madan Raj Aryal, Clifton Bingham

Research output: Contribution to journalArticle

Abstract

Objectives: To report a case of rituximab-induced serum sickness (RISS) and perform a systematic review and characterize RISS in autoimmune diseases and hematological malignancies. Methods: A comprehensive search of MEDLINE, EMBASE, ACR, and EULAR databases was performed for relevant articles of patients with RISS from inception to September 2014. Statistical analysis of demographic and clinical features was performed using Microsoft EXCEL 2007 and SPSS version 20.0. Results: In the 33 patients with RISS, the mean age of presentation was 39.1 ± 17.5 yr with a female preponderance (n = 23, 76.67%). The majority of cases were associated with an underlying rheumatologic condition (n = 17, 51.5%), most commonly Sjögren's syndrome (n = 8, 44.4%). The classic triad of serum sickness (fever, rash, and arthralgia) was reported in 16 (48.5%) cases. Time from drug exposure to symptom onset was significantly greater with the first doses of rituximab compared to the second dose (mean time 10.00 vs. 4.05. d, P = 0.002), and time to resolution was significantly greater for rheumatologic vs. hematological indications (mean time 2.50 vs. 1.00. d, P = 0.035). Corticosteroids were the most commonly used treatment (n = 21), with all cases reporting a complete resolution of symptoms in 2.15 ± 1.34 d. Conclusion: It is important to recognize RISS clinically, as it may mimic exacerbation of various rheumatologic conditions. Although RISS is typically self-limited, further infusions of rituximab should be avoided, as it may provoke more severe symptoms.

Original languageEnglish (US)
Pages (from-to)334-340
Number of pages7
JournalSeminars in Arthritis and Rheumatism
Volume45
Issue number3
DOIs
StatePublished - Dec 1 2015

Fingerprint

Serum Sickness
Rituximab
Arthralgia
Hematologic Neoplasms
Exanthema
MEDLINE
Autoimmune Diseases
Adrenal Cortex Hormones
Fever
Demography
Databases

Keywords

  • Infusion reaction
  • Rheumatoid arthritis
  • Rituximab
  • Serum sickness

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

Karmacharya, P., Poudel, D. R., Pathak, R., Donato, A. A., Ghimire, S., Giri, S., ... Bingham, C. (2015). Rituximab-induced serum sickness: A systematic review. Seminars in Arthritis and Rheumatism, 45(3), 334-340. https://doi.org/10.1016/j.semarthrit.2015.06.014

Rituximab-induced serum sickness : A systematic review. / Karmacharya, Paras; Poudel, Dilli Ram; Pathak, Ranjan; Donato, Anthony A.; Ghimire, Sushil; Giri, Smith; Aryal, Madan Raj; Bingham, Clifton.

In: Seminars in Arthritis and Rheumatism, Vol. 45, No. 3, 01.12.2015, p. 334-340.

Research output: Contribution to journalArticle

Karmacharya, P, Poudel, DR, Pathak, R, Donato, AA, Ghimire, S, Giri, S, Aryal, MR & Bingham, C 2015, 'Rituximab-induced serum sickness: A systematic review', Seminars in Arthritis and Rheumatism, vol. 45, no. 3, pp. 334-340. https://doi.org/10.1016/j.semarthrit.2015.06.014
Karmacharya P, Poudel DR, Pathak R, Donato AA, Ghimire S, Giri S et al. Rituximab-induced serum sickness: A systematic review. Seminars in Arthritis and Rheumatism. 2015 Dec 1;45(3):334-340. https://doi.org/10.1016/j.semarthrit.2015.06.014
Karmacharya, Paras ; Poudel, Dilli Ram ; Pathak, Ranjan ; Donato, Anthony A. ; Ghimire, Sushil ; Giri, Smith ; Aryal, Madan Raj ; Bingham, Clifton. / Rituximab-induced serum sickness : A systematic review. In: Seminars in Arthritis and Rheumatism. 2015 ; Vol. 45, No. 3. pp. 334-340.
@article{06e711dd86e74677b87e6c2b45cd364d,
title = "Rituximab-induced serum sickness: A systematic review",
abstract = "Objectives: To report a case of rituximab-induced serum sickness (RISS) and perform a systematic review and characterize RISS in autoimmune diseases and hematological malignancies. Methods: A comprehensive search of MEDLINE, EMBASE, ACR, and EULAR databases was performed for relevant articles of patients with RISS from inception to September 2014. Statistical analysis of demographic and clinical features was performed using Microsoft EXCEL 2007 and SPSS version 20.0. Results: In the 33 patients with RISS, the mean age of presentation was 39.1 ± 17.5 yr with a female preponderance (n = 23, 76.67{\%}). The majority of cases were associated with an underlying rheumatologic condition (n = 17, 51.5{\%}), most commonly Sj{\"o}gren's syndrome (n = 8, 44.4{\%}). The classic triad of serum sickness (fever, rash, and arthralgia) was reported in 16 (48.5{\%}) cases. Time from drug exposure to symptom onset was significantly greater with the first doses of rituximab compared to the second dose (mean time 10.00 vs. 4.05. d, P = 0.002), and time to resolution was significantly greater for rheumatologic vs. hematological indications (mean time 2.50 vs. 1.00. d, P = 0.035). Corticosteroids were the most commonly used treatment (n = 21), with all cases reporting a complete resolution of symptoms in 2.15 ± 1.34 d. Conclusion: It is important to recognize RISS clinically, as it may mimic exacerbation of various rheumatologic conditions. Although RISS is typically self-limited, further infusions of rituximab should be avoided, as it may provoke more severe symptoms.",
keywords = "Infusion reaction, Rheumatoid arthritis, Rituximab, Serum sickness",
author = "Paras Karmacharya and Poudel, {Dilli Ram} and Ranjan Pathak and Donato, {Anthony A.} and Sushil Ghimire and Smith Giri and Aryal, {Madan Raj} and Clifton Bingham",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.semarthrit.2015.06.014",
language = "English (US)",
volume = "45",
pages = "334--340",
journal = "Seminars in Arthritis and Rheumatism",
issn = "0049-0172",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Rituximab-induced serum sickness

T2 - A systematic review

AU - Karmacharya, Paras

AU - Poudel, Dilli Ram

AU - Pathak, Ranjan

AU - Donato, Anthony A.

AU - Ghimire, Sushil

AU - Giri, Smith

AU - Aryal, Madan Raj

AU - Bingham, Clifton

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives: To report a case of rituximab-induced serum sickness (RISS) and perform a systematic review and characterize RISS in autoimmune diseases and hematological malignancies. Methods: A comprehensive search of MEDLINE, EMBASE, ACR, and EULAR databases was performed for relevant articles of patients with RISS from inception to September 2014. Statistical analysis of demographic and clinical features was performed using Microsoft EXCEL 2007 and SPSS version 20.0. Results: In the 33 patients with RISS, the mean age of presentation was 39.1 ± 17.5 yr with a female preponderance (n = 23, 76.67%). The majority of cases were associated with an underlying rheumatologic condition (n = 17, 51.5%), most commonly Sjögren's syndrome (n = 8, 44.4%). The classic triad of serum sickness (fever, rash, and arthralgia) was reported in 16 (48.5%) cases. Time from drug exposure to symptom onset was significantly greater with the first doses of rituximab compared to the second dose (mean time 10.00 vs. 4.05. d, P = 0.002), and time to resolution was significantly greater for rheumatologic vs. hematological indications (mean time 2.50 vs. 1.00. d, P = 0.035). Corticosteroids were the most commonly used treatment (n = 21), with all cases reporting a complete resolution of symptoms in 2.15 ± 1.34 d. Conclusion: It is important to recognize RISS clinically, as it may mimic exacerbation of various rheumatologic conditions. Although RISS is typically self-limited, further infusions of rituximab should be avoided, as it may provoke more severe symptoms.

AB - Objectives: To report a case of rituximab-induced serum sickness (RISS) and perform a systematic review and characterize RISS in autoimmune diseases and hematological malignancies. Methods: A comprehensive search of MEDLINE, EMBASE, ACR, and EULAR databases was performed for relevant articles of patients with RISS from inception to September 2014. Statistical analysis of demographic and clinical features was performed using Microsoft EXCEL 2007 and SPSS version 20.0. Results: In the 33 patients with RISS, the mean age of presentation was 39.1 ± 17.5 yr with a female preponderance (n = 23, 76.67%). The majority of cases were associated with an underlying rheumatologic condition (n = 17, 51.5%), most commonly Sjögren's syndrome (n = 8, 44.4%). The classic triad of serum sickness (fever, rash, and arthralgia) was reported in 16 (48.5%) cases. Time from drug exposure to symptom onset was significantly greater with the first doses of rituximab compared to the second dose (mean time 10.00 vs. 4.05. d, P = 0.002), and time to resolution was significantly greater for rheumatologic vs. hematological indications (mean time 2.50 vs. 1.00. d, P = 0.035). Corticosteroids were the most commonly used treatment (n = 21), with all cases reporting a complete resolution of symptoms in 2.15 ± 1.34 d. Conclusion: It is important to recognize RISS clinically, as it may mimic exacerbation of various rheumatologic conditions. Although RISS is typically self-limited, further infusions of rituximab should be avoided, as it may provoke more severe symptoms.

KW - Infusion reaction

KW - Rheumatoid arthritis

KW - Rituximab

KW - Serum sickness

UR - http://www.scopus.com/inward/record.url?scp=84955702601&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955702601&partnerID=8YFLogxK

U2 - 10.1016/j.semarthrit.2015.06.014

DO - 10.1016/j.semarthrit.2015.06.014

M3 - Article

C2 - 26199061

AN - SCOPUS:84955702601

VL - 45

SP - 334

EP - 340

JO - Seminars in Arthritis and Rheumatism

JF - Seminars in Arthritis and Rheumatism

SN - 0049-0172

IS - 3

ER -