Document Detail


Rituximab for thrombotic thrombocytopenic purpura: benefit of early administration during acute episodes and use of prophylaxis to prevent relapse.
MedLine Citation:
PMID:  23279219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Rituximab has been documented in the treatment of acute (≤ 3 days from admission), relapsed/refractory thrombotic thrombocytopenic purpura (TTP) and given as prophylaxis in selected cases to prevent acute relapse. The precise timing of rituximab in acute TTP has not been determined.
OBJECTIVE: To perform a retrospective analysis of rituximab use in a large TTP referral center over an 8-year period.
PATIENTS/METHODS: We assessed response to treatment and outcome for all patients treated with rituximab, including 91 patients presenting with 104 episodes of acute TTP and 15 patients given rituximab as prophylaxis to prevent relapse. In the acute TTP group we assessed the benefit of giving early (≤ 3 days from admission) vs. later (> 3 days) rituximab.
RESULTS: In acute de novo TTP, previously untreated with rituximab, rituximab was given ≤ 3 days from admission to 54 patients and > 3 days from admission to 32 patients. Earlier administration (≤ 3 days) was associated with faster attainment of remission (12 vs. 20 days, P < 0.001), fewer plasma exchanges (16 vs. 24, P = 0.03) and shorter hospital stay (16 vs. 23 days, P = 0.01). Eighty-two patients (95%) achieved complete remission within 14 days (4-52 days); four patients died acutely. Eleven out of 82 (13.4%) relapsed at a median of 24 months (4-49 months). Rituximab prophylaxis was associated with normalization of ADAMTS13 levels within 3 months in all but one case, with only one acute relapse at follow-up.
CONCLUSIONS: Although limited by being retrospective and non-randomized, this study demonstrates the potential benefit of early administration of rituximab in acute TTP, and prophylactic use to prevent acute relapse.
Authors:
J-P Westwood; H Webster; S McGuckin; V McDonald; S J Machin; M Scully
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  11     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-15     Completed Date:  2013-08-30     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  481-90     Citation Subset:  IM    
Copyright Information:
© 2012 International Society on Thrombosis and Haemostasis.
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MeSH Terms
Descriptor/Qualifier:
ADAM Proteins / blood
Acute Disease
Adolescent
Adult
Aged
Antibodies, Monoclonal, Murine-Derived / administration & dosage*,  adverse effects
Biological Markers / blood
Child
Disease-Free Survival
Drug Administration Schedule
Female
Great Britain
Humans
Immunologic Factors / administration & dosage*,  adverse effects
Kaplan-Meier Estimate
Male
Middle Aged
Purpura, Thrombotic Thrombocytopenic / blood,  diagnosis,  drug therapy*,  mortality
Recurrence
Registries
Retrospective Studies
Tertiary Care Centers
Time Factors
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
G0800671//Medical Research Council; //Medical Research Council
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Murine-Derived; 0/Biological Markers; 0/Immunologic Factors; 0/rituximab; EC 3.4.24.-/ADAM Proteins; EC 3.4.24.-/ADAMTS13 protein, human

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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