Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective
1 Department of Medicine, University of Pittsburgh Medical Center, N713 UPMC Montefiore, 200 Lothrop Street, Pittsburgh, PA 15213, USA
2 Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, 5150 Centre Avenue, Pittsburgh, PA 15232, USA
3 Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Arthritis Institute, S705 BST, 3500 Terrace Street, Pittsburgh, PA 15261, USA
Critical Care 2012, 16:231 doi:10.1186/cc11304Published: 31 August 2012
The advent of biologic agents has provided a more specific and targeted approach to the treatment of various hematological malignancies and other autoimmune disorders. Such biologic agents have been relatively well tolerated with fewer adverse events reported as compared with many other chemotherapeutic agents. Rituximab is a monoclonal antibody to the B-cell marker CD20 and is a common biologic agent widely used for the treatment of B-cell lymphoma, lymphoproliferative disorders, and inflammatory conditions that are refractory to conventional treatment, including rheumatoid arthritis and some vasculitides. However, through randomized controlled trials and post-marketing surveillance, an increasing number of serious adverse events are being associated with the use of rituximab, often leading to or complicating an intensive care unit admission. The purpose of this review is to focus on the severe complications that are associated with the use of rituximab and that require critical care. Management and prevention strategies for the most common complications along with some examples of its uses within the critical care setting are also discussed.