PS1515 PREMEDICATION WITH MONTELUKAST AND RUPATADINE DECREASES INFUSION TIME, RATE AND SEVERITY OF REACTIONS AND OVERALL COST OF RITUXIMAB ADMINISTRATION

Abstract

Background:Rituximab is associated with frequent infusion reactions, which carry significant burden to both patients and health care practitioners. Standard pre‐medications (SP) do not prevent reactions sufficiently. Montelukast (M) and Rupatadine (R) are used for treatment of urticarial, allergic rhinitis, and may impact Rituximab infusionAims:We assessed impact of addition of R, M and their combination (R+M) on Rituximab infusion/rate, rate/severity of reactions and administration costMethods:Adult patients with lymphoproliferative disorders treated at our cancer center between Jan 2018 to Jan 2019 were evaluated with Rituximab‐containing regiments. Since the majority of reactions occur during the first infusion, our study was limited to the initial Rituximab treatment. Patients received either SP with diphenhydramine/acetaminophen and additional R, M or R+M combination. Comparative analysis of infusion time/rate, severity of infusion reactions, number of rescue medications and cost of Rituximab infusions among groups was performed using one‐way ANOVA with Tukey post‐hoc or chi‐square. The study was approved by our institutional ethics boardResults:Patients received either: 1) standard premedications (SP); 2) SP + Rupatadine (R) 10 mg; 3) SP + Montelukast (M) 10 mg; or 4) both (SP+R+M). Patient characteristics and therapy are shown in Table 1. Compared to SP, the R, M and R+M groups had greater improvement in Rituximab delivery. Mean infusion time was 305 [range 235–441] min. in SP, 254 [105–390] in M, 265 [193–350] in R and 238 [196–342] in R+M groups, (p = 0.0001). Infusion reactions occurred in 92% in SP vs. 38, 45, 31% in M, R and R+M groups (p = 0.0001). Median reaction grade was 2 in SP, 1 (M), 0 (R and R+M). Median number of rescue medications was 3 [0–10] in SP vs 0 [0–7] in M, R and R+M groups. Cost of rescue medications (US$) was 41 [0–63] (SP), 11 [0–50] (M), 17 [0–63] (R), 7 [0–58] (R+M) groups (p < 0.0001). Mean nursing cost (US$) per patient infusion was calculated as 269 [207–388] in SP vs 222 [92–343] (M), 233 [170–308] (R), 209 [174–301] (R+M) group.RCHOP, Rituximab/Cyclophosphamide/Doxorubicin/ Oncovin/Prednisone; BR, Bendamustine/Rituximab; FCR, Fludarabine/Cyclophosphamide/RituximabimageSummary/Conclusion:Addition of R, M and particularly R+M combination significantly improved Rituximab delivery, decreased the rate and severity of infusion reactions, and lowered the cost of Rituximab administration