From the Guidelines
Rituximab should be considered for Thrombotic Thrombocytopenic Purpura (TTP) that has not responded to standard treatments, such as plasma exchange or intravenous immunoglobulin, as evidenced by a recent study published in the BMJ in 2021 1. When managing TTP, the primary goal is to reduce morbidity, mortality, and improve quality of life by preventing further thrombotic events and promoting platelet count recovery.
- Key considerations for rituximab use in TTP include:
- Refractory or relapsing disease
- Severe initial presentations
- Failure to respond to plasma exchange or intravenous immunoglobulin
- The dosing regimen and administration schedule for rituximab in TTP may vary, but it is typically administered as an intravenous infusion.
- The mechanism of action of rituximab involves depleting B cells, which reduces production of autoantibodies against ADAMTS13, a crucial enzyme in preventing microvascular thrombosis.
- Patients receiving rituximab should be closely monitored for potential side effects, including infusion reactions and infections, as noted in the study published in the BMJ 1.
- It is essential to weigh the benefits and risks of rituximab treatment in TTP, considering the potential for improved outcomes and reduced morbidity and mortality, as supported by recent evidence 1.
From the Research
Timing of Rituximab Administration in TTP
- Rituximab can be given in the treatment of acute (≤ 3 days from admission), relapsed/refractory thrombotic thrombocytopenic purpura (TTP) and as prophylaxis in selected cases to prevent acute relapse 2.
- Earlier administration (≤ 3 days) of rituximab is associated with faster attainment of remission, fewer plasma exchanges, and shorter hospital stay in acute de novo TTP 2.
- Rituximab can be considered in TTP patients with acquired ADAMTS-13 deficiency who fail to respond clinically after 7-14 days of standard treatment with daily plasma exchange and glucocorticoids 3.
Indications for Rituximab in TTP
- Rituximab is used in adult patients with idiopathic relapsing or refractory TTP, and has been shown to be safe and effective in achieving complete remission 4.
- Rituximab can be used in Japanese patients with acquired TTP refractory to conventional therapy, with a response rate of 33.3% 5.
- Rituximab is also effective in treating refractory and relapsing TTP, with complete remission achieved in all patients after a median time of 14.4 days of the first dose 6.