Subcutaneous rituximab demonstrates comparable efficacy and safety to its intravenous counterpart in treating non-Hodgkin lymphoma, while also offering significant cost and time savings, according to a meta-analysis presented at the 2024 Society of Hematologic Oncology (SOHO) Annual Meeting. The research, encompassing 1562 participants across seven studies, suggests a potential shift towards increased utilization of the subcutaneous formulation.
Efficacy and Safety
The meta-analysis revealed no statistically significant differences between subcutaneous and intravenous rituximab in terms of complete response (CR), partial response (PR), or overall response (OR). Specifically, the odds ratio for CR was 1.21 (95% CI, 0.96-1.53), for PR was 0.87 (95% CI, 0.69-1.10), and for OR was 1.11 (95% CI, 0.80-1.54). These findings indicate that the route of administration does not significantly impact the treatment's effectiveness.
Safety profiles were also similar between the two administration methods. The odds ratio for grade 3 or higher adverse events (AEs) was 1.04 (95% CI, 0.83-1.32), and for any-grade AEs, it was 0.90 (95% CI, 0.63-1.27). However, subcutaneous rituximab was associated with a higher rate of administration-related events (OR, 1.69; 95% CI, 1.31-2.19).
Cost and Time Efficiency
One of the most compelling findings of the meta-analysis was the significant cost savings associated with subcutaneous rituximab. The mean difference in total costs was –173.71 (95% CI, –195.04 to –152.39), indicating a substantial reduction in expenses. Pharmacy technique costs (MD, –0.66; 95% CI, –1.03 to 0.29) and administration costs (MD, –85.61; 95% CI, –152.28 to –18.95) were also lower for the subcutaneous formulation. Furthermore, the total process time was significantly reduced with subcutaneous administration (MD, –48.91; 95% CI, –53.61 to –44.22).
Implications and Limitations
According to Khaled Albakri, MS, a medical student at The Hashemite University in Jordan, "Our study highlights the importance of education and training to increase the utilization of subcutaneous rituximab in the context of non-Hodgkin lymphoma treatment." The reduced cost and time associated with subcutaneous rituximab could lead to improved resource allocation and patient convenience.
The authors noted several limitations to the analysis, including the small number of included studies, variations in study designs, and heterogeneity in some of the results. These limitations suggest the need for further research to validate these findings and explore the optimal use of subcutaneous rituximab in clinical practice.
