By Thomas S. May
TORONTO -- June 3, 2008 – Rituximab, when added to IV immunoglobulin (IVIG) and given in a single dose, is as effective as 2 doses in desensitising patients who are highly sensitised to human leukocyte antigen (HLA) and who are awaiting living-donor (LD) or deceased-donor (DD) kidney transplants, according to a study presented here at the 2008 American Transplant Congress (ATC).
The study, presented during a poster session on June 1, was conducted by Ashley A. Vo, PharmD, Transplant Immunotherapy Program, University of California at Los Angeles School of Medicine, Los Angeles, California.
In previous research, Dr. Vo's team demonstrated success in 80% of patients awaiting kidney transplantation using a combination of 2 doses of IVIG and 2 doses of rituximab over a 5-week period to desensitise patients who were highly HLA-sensitised. "From that study, we saw significant B-cell depletion after just 1 dose of rituximab; thus, we modified our protocol to give 2 doses of IVIG and 1 dose of rituximab over a 4-week course," Dr. Vo explained.
For their new study, Dr. Vo and colleagues compared 2 desensitisation strategies: IVIG 2 gm/kg on days 1 and 30 plus 2 doses of rituximab 1 gm on days 7 and 22 (group 1); or IVIG 2 gm/kg on days 1 and 30 plus 1 dose of rituximab 1 gm given on day 15 (group 2).
All 16 patients in group 1 received induction therapy with alemtuzumab while patients in group 2 received alemtuzumab (n = 33), daclizumab (n = 19), or antithymocyte globulin (n = 3). All patients were maintained on tacrolimus, mycophenolate, and steroids.
An analysis of the results found no significant differences in graft survival, mean serum creatinine values, or infection rates between the 2 groups; the rate of acute rejections was significantly lower among subjects in group 2.
These data indicate that the administration of IVIG plus a single dose of rituximab allows for more rapid and effective desensitisation of highly HLA-sensitised patients awaiting transplantation compared with IVIG plus 2 doses of rituximab, the researchers concluded.
[Presentation title: Comparison of Two Desensitisation Strategies Using IVIG and Rituximab to Improve Transplantation Rates in Highly-HLA Sensitized Patients (HS) Awaiting Living (LD) and Deceased Donor (DD) Transplants. Abstract 651]
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