Indications and Safety of Rituximab in Pediatric Neurology: A 10-Year Retrospective Study - 08/11/22

Doi : 10.1016/j.pediatrneurol.2022.08.004

Ai Tien Nguyen, MD ^a, Camille Cotteret, PharmD ^b, Chloé Durrleman, MD ^a, Christine Barnerias, MD ^a, Marie Hully, MD ^a, Cyril Gitiaux, MD, PhD ^a, Bettina Mesples, MD, PhD ^c, Jacinta Bustamante, MD, PhD ^d,^e, Stéphanie Chhun, PharmD, PhD ^f, Claire Fayard, PharmD ^b, Salvatore Cisternino, PharmD, PhD ^b, Jean-Marc Treluyer, MD, PhD ^g, Isabelle Desguerre, MD, PhD ^a, Mélodie Aubart, MD, PhD ^a,^e,^⁎
^a Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
^b Department of Clinical Pharmacy, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
^c Department of Pediatrics, Louis Mourier Hospital, University of Paris, AP-HP, Paris, France
^d Study Center for Primary Immunodeficiencies, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
^e Human Genetics of Infectious Diseases, INSERM UMR 1163, University of Paris, Institut Imagine, Paris, France
^f Laboratory of Immunology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
^g Clinical Research Unit, Necker-Enfants maladies Hospital, University of Paris, AP-HP, Paris, France

^∗Communications should be addressed to: Dr. Aubart; Pediatric Neurology Departement; Hôpital Universitaire Necker-Enfants Malades; Paris, France.Pediatric Neurology DepartementHôpital Universitaire Necker-Enfants MaladesParisFrance

Abstract

Background

RTX is used off-label in several neurological inflammatory diseases in adults children patients. We conducted a study to assess indications and safety of rituximab (RTX) for children and to identify risk factors for early B-cell repopulation.

Methods

A single-center retrospective study of children treated with RTX for a neurological disease between May 31, 2010, and May 31, 2020, was performed.

Results

A total of 77 children (median age, 8.9 years) were included. RTX was mostly used as second-line therapy in all groups of diseases (68%). Median dose was 1500 mg/m² for each patient. There were 13 clinical relapses (17%), 5 when B-cell depletion was complete. Adverse events were present in 6% of the cases. The factors influencing early B-cell repopulation were the recent infusion of intravenous Ig (P < 0.01) and the administration of less than 1500 mg/m² during the first RTX treatment (P = 0.04). The median time to B-cell repopulation seemed to be shorter (160 vs 186 days) when patients had plasmapheresis even when a 48-hour delay was observed with RTX infusions.

Conclusions

This study confirms the good tolerance of RTX in the treatment of specific neurological disorders in a pediatric population. It also highlights risk factors for early B-cell repopulation and underlines the importance of B-cell monitoring.

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Keywords : Rituximab, Encephalitis, Neuromyelitis optica, B lymphocytes

Plan

Introduction

Patients and Method

Results

Clinical cohort and subgroup demographics

Indications for RTX

RTX administration

Follow-up and complications

Treatment duration, discontinuation, and treatments after RTX

Relapses

Outcome

Comparative analysis in B-cell repopulation

Discussion

Conclusion

Declarations of interest: None.

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Vol 137

P. 41-48 - décembre 2022 Retour au numéro

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Indications and Safety of Rituximab in Pediatric Neurology: A 10-Year Retrospective Study - 08/11/22

Abstract

Background

Methods

Results

Conclusions

Plan

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