A multicenter recall survey of the side effects of Rituximab in Iranian children with kidney disease

Abstract

Introduction: Rituximab is a monoclonal antibody against CD20 marker of B lymphocytes that is widely used in the treatment of various diseases including malignancies, connective tissue diseases, nephrotic syndrome, and organ transplantation. Side effects of rituximab include early and late-onset complications and range from allergic reactions in mild early onset to severe anaphylactic shock. Late-onset lymphoproliferative disorders (PTLD) have been reported as a long term complication. Since it has been used in patients with nephrotic syndrome, evaluation of early and long term side effects is very important.  Materials and Methods: This study was conducted in 18 districts of Iran. 27 university-affiliated hospitals were recruited and 31 pediatric nephrologists completed the questionnaires. A questionnaire containing patient's demographic data, use of rituximab in kidney diseases, times of injections, protocol of receiving medication, and early and late side effects was sent to all collaborators via email. The completed questionnaires were collected via e-mail. Results: The results from recall showed that of the nephrologists who completed the questionnaires, 65.5% prescribed medication in less than 10 eligible patients and 34.5% prescribed rituximab in more than 10 patients in the last year. Side effects during the administration were reported in 77%, the most common being fever, chills, and rigor. Mild and early complications were reported in 54%. Infection, cardiovascular, pulmonary and renal disorders were the most reported side effects. Conclusion: Despite the numerous and serious side effects of rituximab reported in the literature, it seems to be a safe drug for patients with nephrotic syndrome.