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. 2013 Jun;162(6):1252-8, 1258.e1.
doi: 10.1016/j.jpeds.2012.11.038. Epub 2012 Dec 24.

Leveraging administrative data to monitor rituximab use in 2875 patients at 42 freestanding children's hospitals across the United States

Marko Kavcic  1 , Brian T Fisher, Alix E Seif, Yimei Li, Yuan-Shung Huang, Dana Walker, Richard Aplenc
Affiliations

Leveraging administrative data to monitor rituximab use in 2875 patients at 42 freestanding children's hospitals across the United States

Marko Kavcic et al. J Pediatr. 2013 Jun.

Abstract

Objective: To describe the pharmacoepidemiology of rituximab use in children and to estimate the frequency of infectious events within a 1-year period after rituximab exposure.

Study design: This is a retrospective cohort study of patients who received rituximab at 1 of 42 children's hospitals contributing data to the Pediatric Health Information System between January 1999 and June 2011. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis codes were analyzed to categorize underlying diseases (hematologic malignancies, primary immunodeficiencies, autoimmune diseases, and transplant recipients) and to estimate inpatient infectious complication rates within each category.

Results: A total of 2875 patients with 4639 rituximab admissions were identified. The median age at index admission was 11 years (IQR, 5-15 years). The rate of rituximab admissions increased from 3 to 185 per 100,000 admissions per year over the study interval. During the 1-year follow-up period, 463 patients (16%) died. Infectious events were assessed in 2246 of the rituximab-exposed patients; 6.1% were diagnosed with sepsis and 2.0% with septic shock. The frequency of sepsis ranged from 2.4% in patients with autoimmune diseases to 12.2% in those with primary immunodeficiencies. Three patients were assigned an ICD-9-CM discharge diagnosis code for Pneumocystis joroveci pneumonia, 1 patient was assigned an ICD-9-CM discharge diagnosis code for hepatitis B, and 1 patient was assigned an ICD-9-CM discharge diagnosis code for progressive multifocal leukoencephalopathy.

Conclusion: The use of rituximab has increased significantly in children with a variety of underlying diseases. Based on ICD-9-CM code data, the rates of sepsis and other life-threatening infections after rituximab exposure vary depending on the underlying condition. Based on surveillance of infection using ICD-9-CM diagnosis codes, the rates of opportunistic infections appear to be low.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Identification of the rituximab study cohort. CTC, Clinical Transaction Classification.
Figure 2
Figure 2
Rate of rituximab use over time.
See this image and copyright information in PMC

References

    1. Solal-Céligny P. Safety of rituximab maintenance therapy in follicular lymphomas. Leuk Res. 2006;30(Suppl 1):S16–S21. - PubMed
    1. Willems M, Haddad E, Niaudet P. Rituximab therapy for childhood-onset systemic lupus erythematosus. J Pediatr. 2006;148:623–627. - PubMed
    1. Keystone E, Fleischmann R, Emery P, Furst DE, van Vollenhoven R, Bathon J, et al. Safety and efficacy of additional courses of rituximab in patients with active rheumatoid arthritis: an open-label extension analysis. Arthritis Rheum. 2007;56:3896–3908. - PubMed
    1. Grim SA, Pham T, Thielke J, Sankary H, Oberholzer J, Benedetti E, et al. Infectious complications associated with the use of rituximab for ABO-incompatible and positive cross-match renal transplant recipients. Clin Transplant. 2007;21:628–632. - PubMed
    1. Aksoy S, Harputluoglu H, Kilickap S, Dede DS, Dizdar O, Altundag K, et al. Rituximab-related viral infections in lymphoma patients. Leuk Lymphoma. 2007;48:1307–1312. - PubMed

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