類風溼關節炎患者之莫須瘤輸注反應危險因子：單一中心五年459次輸注經驗探討

Risk factor of infusion-related reactions of rituximab in rheumatoid arthritis: single-center experience of 459 infusions over 5 years

目的：探討接受莫須瘤治療之類風濕性關節炎患者發生輸注反應的可能相關因素。方法：將五年內曾經接受莫須瘤治療之類風濕性關節炎患者，以病歷回顧之方式記錄發生輸注反應發生的嚴重程度與處置方式，並加以分析。結果：本研究共收錄68位類風濕性關節炎患者，共459次莫須瘤輸注。針對每位患者第一次輸注作分析，可發現過去曾經接受其他種類生物製劑的患者（n＝35），有輸注反應發生7人（20%）；比較未曾接受過其他生物製劑者（n＝33），輸注反應發生1人（3%）。進一步依據輸注流速做存活分析，納入459次莫須瘤輸注，接受其他種類生物製劑的患者之輸注反應存活曲線有顯著與未曾接受者分開。結論：過去曾經接受其他種類生物製劑的類風濕性關節炎患者，接受莫須瘤輸注治療時，有較高機會發生輸注反應。

Objective: To identify possible risk factors associated with rituximab (RTX) infusion-related reaction (IRR) in patients with rheumatoid arthritis. We analyzed data from one medical center from Taiwan. Methods: Patients diagnosed with rheumatoid arthritis who received RTX infusion were retrospectively reviewed from January 2013 to December 2017. Patient characteristics and the results of serological markers were collected for data analysis. Results: A total of 68 patients with a total of 459 RTX infusions were identified; 35 (51.4%) patients had previously received biologic agents, and there were seven grade I IRR events in this group compared with only one IRR event in 33 (48.52%) biologic-naive patients. After adjusting the infusion rate, further analysis showed that biologic-experienced patients had a higher rate of developing IRRs. The incidence rate of IRRs decreased with an increase in the number of treatment cycles. Conclusion: In patients with rheumatoid arthritis receiving RTX infusion, biologic-experienced patients had a higher rate of developing IRRs compared with biologic-naive patients.