利妥昔单抗(RTX)是一种嵌合单克隆抗体,靶向B细胞上的CD20抗原,用于各种自身免疫性疾病。在这项研究中,我们旨在通过一项调查来衡量儿科风湿病学家对使用RTX的认识.在2023年2月至3月之间,通过电子邮件向土耳其的儿科风湿病专家发送了42个问题的调查。参与者被问及他们更喜欢使用RTX的诊断和系统参与,他们进行了哪些常规测试,疫苗接种政策,以及输注期间或之后发生的不良事件。41位儿科风湿病学家回答了这项调查。对于系统性红斑狼疮(87.8%)和ANCA相关性血管炎(9.8%),他们最常使用RTX。在管理RTX之前,95%的临床医生检查了肾功能和肝功能检查,以及免疫球蛋白水平。治疗前最常检测的肝炎标志物是HBsAg和抗HBs抗体(97.6%),而85.4%的风湿病学家检查了抗HCV。临床医生(31.4%)报告说,他们在灭活疫苗后推迟RTX输注2周。61%的风湿病学家报告说,在活疫苗接种后1个月开始RTX治疗,而26.8%的人等待了6个月。最常见的不良事件是RTX输注期间的过敏反应(65.9%),低球蛋白血症(46.3%),和皮疹(36.6%)。如果RTX治疗后出现低丙种球蛋白血症,医师报告称,在静脉注射免疫球蛋白后,他们经常(58.5%)继续使用RTX.
结论:近年来,RTX已成为小儿风湿病的常用治疗选择。临床医生如疫苗接种和常规测试之间的治疗管理可能有所不同。
背景:•在利妥昔单抗治疗过程中,临床医生应注意治疗前的具体考虑,在管理期间,以及治疗后的患者监测。
背景:•临床医生在RTX治疗的管理方面存在实践差异。这些实践差异有可能影响最佳治疗过程。•本研究强调儿科风湿病RTX治疗需要标准化指南,特别是疫苗接种政策和常规测试。
Rituximab (RTX) is a chimeric monoclonal antibody that targets the CD20 antigen on B cells and is used in various autoimmune disorders. In this
study, we aimed to measure the awareness of pediatric rheumatologists about the use of RTX through a survey. Between February and March 2023, a 42-question survey was sent via email to pediatric rheumatology specialists in Turkey. The participants were questioned for which diagnoses and system involvement they preferred to use RTX, which routine tests they performed, vaccination policy, and adverse events that occurred during or after infusion. Forty-one pediatric rheumatologists answered the survey. They prescribed RTX most frequently for systemic lupus erythematosus (87.8%) and ANCA-associated vasculitis (9.8%). Prior to the administration of RTX, 95% of clinicians checked renal and liver function tests, as well as immunoglobulin levels. The most frequently tested hepatitis markers before treatment were HBsAg and anti-HBs antibody (97.6%), while 85.4% of rheumatologists checked for anti-HCV. Clinicians (31.4%) reported that they postpone RTX infusion 2 weeks following an inactivated vaccine. Sixty-one percent of rheumatologists reported starting RTX treatment 1 month after live vaccines, while 26.8% waited 6 months. The most frequent adverse events were an allergic reaction during RTX infusion (65.9%), hypogammaglobulinemia (46.3%), and rash (36.6%). In the event of hypogammaglobulinemia after RTX treatment, physicians reported that they frequently (58.5%) continued RTX after intravenous immunoglobulin administration.
CONCLUSIONS: RTX has become a common treatment option in pediatric rheumatology in recent years. Treatment management may vary between clinician such as vaccination and routine tests.
BACKGROUND: • During the course of rituximab therapy, clinicians should be attentive to specific considerations in pre-treatment, during administration, and in post-treatment patient monitoring.
BACKGROUND: • There are differences in practice among clinicians in the management of RTX therapy. These practice disparities have the potential to impact the optimal course of treatment. • This
study highlights that standardized guidelines are needed for RTX treatment in pediatric rheumatology, particularly for vaccination policies and routine tests.