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Alexander, Marliese; Jachno, Kim; Phillips, Kelly-Anne; Seymour, John F; Slavin, Monica A; Cheung, Ada; Shen, Vivian; Maarouf, Dana; Wolfe, Rory; Lingaratnam, Senthil

Infective complications in cancer patients treated with subcutaneous versus intravenous trastuzumab and rituximab: An individual patient data meta-analysis

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  • Media type: E-Article
  • Title: Infective complications in cancer patients treated with subcutaneous versus intravenous trastuzumab and rituximab: An individual patient data meta-analysis
  • Contributor: Alexander, Marliese; Jachno, Kim; Phillips, Kelly-Anne; Seymour, John F; Slavin, Monica A; Cheung, Ada; Shen, Vivian; Maarouf, Dana; Wolfe, Rory; Lingaratnam, Senthil
  • imprint: SAGE Publications, 2023
  • Published in: Journal of Oncology Pharmacy Practice
  • Language: English
  • DOI: 10.1177/10781552231180875
  • ISSN: 1078-1552; 1477-092X
  • Keywords: Pharmacology (medical) ; Oncology
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Background</jats:title><jats:p> Investigation of infection risk with subcutaneous versus intravenous trastuzumab and rituximab administration in an individual patient data (IPD) and published data meta-analysis of randomised controlled trials (RCTs). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Databases were searched to September 2021. Primary outcomes were serious and high-grade infection. Relative-risk (RR) and 95% confidence intervals (95%CI) were calculated using random-effects models. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> IPD meta-analysis (6 RCTs, 2971 participants, 2320 infections) demonstrated higher infection incidence with subcutaneous versus intravenous administration, without reaching statistical significance (serious: 12.2% versus 9.3%, RR 1.28, 95%CI 0.93to1.77, P = 0.13; high-grade: 12.2% versus 9.9%, RR 1.32, 95%CI 0.98to1.77, P = 0.07). With exclusion of an outlying study in post-hoc analysis, increased risks were statistically significant (serious: 13.1% versus 8.4%, RR 1.53, 95%CI 1.14to2.06, P = 0.01; high-grade: 13.2% versus 9.3%, RR 1.56, 95%CI 1.16to2.11, P &lt; 0.01). Published data meta-analysis (8 RCTs, 3745 participants, 648 infections) demonstrated higher incidence of serious (HR 1.31, 95%CI 1.02to1.68, P = 0.04) and high-grade (HR 1.52, 95%CI 1.17to1.98, P &lt; 0.01) infection with subcutaneous versus intravenous administration. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Results suggest increased infection risk with subcutaneous versus intravenous administration, although IPD findings are sensitive to exclusion of one trial with inconsistent results and identified risk-of-bias. Ongoing trials may confirm findings. Clinical surveillance should be considered when switching to subcutaneous administration. PROSPERO registration CRD42020221866/CRD42020125376. </jats:p></jats:sec>