Document Detail


Population pharmacokinetics of rituximab with or without plasmapheresis in kidney patients with antibody-mediated disease.
MedLine Citation:
PMID:  23432476     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Both rituximab and plasmapheresis can be associated in the treatment of immune-mediated kidney diseases. The real impact of plasmapheresis on rituximab pharmacokinetics is unknown. The aim of this study was to compare rituximab pharmacokinetics between patients requiring plasmapheresis and others without plasmapheresis.
METHODS: The study included 20 patients receiving one or several infusions of rituximab. In 10 patients, plasmapheresis sessions were also performed (between two and six sessions per patient). Rituximab concentrations were measured in blood samples in all patients and in discarded plasma obtained by plasmapheresis using an enzyme-linked immunosorbent assay method. Data were analysed according to a population pharmacokinetic approach.
RESULTS: The mean percentage of rituximab removed during the first plasmapheresis session ranged between 47 and 54% when plasmapheresis was performed between 24 and 72 h after rituximab infusion. Rituximab pharmacokinetics was adequately described by a two-compartment model with first-order elimination. Plasmapheresis had a significant impact on rituximab pharmacokinetics, with an increase of rituximab clearance by a factor of 261 (95% confidence interval 146-376), i.e. from 6.64 to 1733 ml h(-1) . Plasmapheresis performed 24 h after rituximab infusion decreased the rituximab area under the curve by 26%.
CONCLUSIONS: Plasmapheresis removed an important amount of rituximab when performed less than 3 days after infusion. The removal of rituximab led to a significant decrease of the area under the curve. This pharmacokinetic observation should be taken into account for rituximab dosing, e.g. an additional third rituximab infusion may be recommended when three plasmapheresis sessions are performed after the first rituximab infusion.
Authors:
Florent Puisset; Mélanie White-Koning; Nassim Kamar; Antoine Huart; Frédérique Haberer; Hélène Blasco; Chantal Le Guellec; Thierry Lafont; Anaïs Grand; Lionel Rostaing; Etienne Chatelut; Jacques Pourrat
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  British journal of clinical pharmacology     Volume:  76     ISSN:  1365-2125     ISO Abbreviation:  Br J Clin Pharmacol     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-10-23     Completed Date:  2014-08-04     Revised Date:  2014-11-04    
Medline Journal Info:
Nlm Unique ID:  7503323     Medline TA:  Br J Clin Pharmacol     Country:  England    
Other Details:
Languages:  eng     Pagination:  734-40     Citation Subset:  IM    
Copyright Information:
© 2013 The Authors. British Journal of Clinical Pharmacology © 2013 The British Pharmacological Society.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Monoclonal, Murine-Derived / pharmacokinetics*
Area Under Curve
Enzyme-Linked Immunosorbent Assay
Female
Humans
Immunologic Factors / pharmacokinetics*
Kidney Diseases / immunology,  physiopathology,  therapy*
Male
Middle Aged
Models, Biological
Plasmapheresis*
Time Factors
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Murine-Derived; 0/Immunologic Factors; 0/rituximab
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