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J Allergy Clin Immunol Pract. 2016 May-Jun;4(3):497-504. doi: 10.1016/j.jaip.2015.12.019. Epub 2016 Feb 16.

Safety, Costs, and Efficacy of Rapid Drug Desensitizations to Chemotherapy and Monoclonal Antibodies.

Author information

1
Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
2
Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY.
3
Dana Farber Cancer Institute, Harvard Medical School, Boston, Mass.
4
Division of Rheumatology, Allergy, and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: mcastells@partners.org.

Abstract

BACKGROUND:

Rapid drug desensitization (RDD) is used to address hypersensitivity reactions to chemotherapeutics and monoclonal antibodies, allowing patients to be treated with optimal pharmacological agents. RDD protocols are tailored to each individual patient's reaction and needs, and protect against anaphylaxis, but overall risks, costs, and benefits have not been determined.

OBJECTIVE:

We investigated the safety, efficacy, costs, and life expectancy of patients in a large population undergoing RDD.

METHODS:

We analyzed 2177 RDD procedures performed in 370 patients with cancer, vasculitis, and hematological and connective tissue diseases who presented 402 reactions. A subgroup of carboplatin allergic patients with ovarian cancer treated with RDD was analyzed for costs and life expectancy and compared with a nonallergic control group.

RESULTS:

RDD allowed all patients to receive safely the full dose of the medication to which they were reactive. A gradual increase in the fraction of outpatient desensitizations from 81% to 98% was achieved through risk stratification. Of the 2177 desensitizations, 93% had no or mild reactions whereas 7% had moderate to severe reactions, which did not preclude the completion of the treatment, and there were no deaths. Overall health costs in the carboplatin allergic group were not higher than those in the nonallergic group treated with standard of care. Administration of carboplatin through RDD was as effective as standard administration with a nonsignificant increase in life expectancy in desensitized patients as compared with nonallergic, nondesensitized controls.

CONCLUSIONS:

RDD is cost effective and safe for allergic patients with cancer and chronic disease to remain on first line therapy.

KEYWORDS:

Carboplatin; Chemotherapeutic agents; Cost; Drug desensitization; Drug hypersensitivity; Efficacy; Monoclonal antibodies; Safety

PMID:
26895621
DOI:
10.1016/j.jaip.2015.12.019
[Indexed for MEDLINE]

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