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Subcutaneous Rituximab Prefered Over Intravenous Formulation for NHL in Clinical Practice

 

Mitul Gandhi, MD, Virginia Cancer Specialists, Gainesville, discusses results from a study exploring real-world data on patient and provider preferences of rituximab administration for non-Hodgkin lymphoma (NHL), showing that both parites prefer the subcutaneous administration of the drug over intravenous administration.

This study was presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting.

Transcript

My name is Mitul Gandhi. I'm a medical oncologist and hematologist, part of Virginia Cancer Specialists. We're one of the practices in the US Oncology Network. I am involved in the clinical research program and have a particular interest in hematological malignancies.

The study that we're discussing today is titled "Patient and Nurse Preference of Subcutaneous Rituximab Injection vs Intravenous Rituximab Infusion." It's a real-world study. This was a study performed in collaboration with Genentech, along with our US Oncology colleagues.

The premise of it is that rituximab is one of the cornerstones in chemoimmunotherapy and has been the case for almost two decades in non-Hodgkin lymhoma. It's primarily administered in an intravenous route in a rate-escalated fashion, particularly, on the first dose.

There has been a recent formulary in 2017 that was introduced which can administer rituximab subcutaneously, and it had equivalent pharmacokinetic and efficacy data compared to the intravenous version.

It's been somewhat taken up in the community, but it's a bit uncertain to both patient and nurse assessment of their preferences and perceptions of their experience with both the intravenous and in the subcutaneous formulation.

This was a survey-based assessment to gauge both patient and nurse providers in terms of their preference of subcutaneous versus intravenous rituximab in a real-world, community oncology setting at US Oncology sites.

A survey was crafted and then distributed amongst volunteer patients and nursing staff. 70 patients elected to participate, or rather, were invited to the study, and 29 elected to complete it. Out of 208 nurse providers invited, 36 completed it.

It was pretty representative of a lymphoma population in terms of the patient component of it. About 40% had follicular lymphoma, another 40% had large-cell lymphoma, and a small subset had CLL.

Similarly, with respect to the nurses, there was a pretty broad range in terms of age, experience in terms of the nurses. The vast majority of the nurses had at least a year of clinical experience.

When we did the survey and looked at the data, what became fairly clear is there was a preference for the subcutaneous version compared to the intravenous version. Specifically, 69% of the patients preferred the subcutaneous version over the intravenous. One of the driving factors was the less time in clinic, and so, a lot of time saved.

Similarly, that was one of the main preferred reasons from the nurses as well. 58% of the nurses preferred the subcutaneous versus the intravenous version, with 95% of them stipulating the time saved as the primary factor.

Partly the other thing that they observed was whether it was just more convenient. Patients seemed to prefer it more, and it saved them time in terms of administrative and documentation tasks as well. And so, it was a consolation of benefits, both with respect to time saved, patient preference that drove what the nurses felt as well.

As we looked through and combed through all the data, it became pretty clear that the majority of patients seemed to prefer the subcutaneous version compared to the intravenous version. This is a real-world assessment and provides some important information as to how both nurses and patients felt on rituximab dosing and how it impacted their quality of experience with their treatment.

We were happy to report that on behalf of all the partners involved in the study, along with our pharmaceutical partner, Genentech.   


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