Adverse events of patients receiving rituximab, bevacizumab and omalizumab at King Chulalongkorn Memorial Hospital

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Mali Wirotesangthong
Ployrung Chiangung
Sireetorn Klinpakdee
Issaree Poochan
Bovornpat Suriyapakorn


Monoclonal antibodies (MAbs) have been widely used for treatment of many diseases. Mouse-derived MAbs were the first MAb used in humans. However, the presence of human anti-mouse antibody was often reported following its use. Consequently, chimeric and humanized MAbs were developed to reduce immunogenicity by protein contents. Nevertheless, adverse events (AEs) have been reported from patients receiving these two MAbs drugs in many countries. AEs from patients in Thailand have not been systemically investigated. This research aims to report AEs from Thai patients using monoclonal antibody drugs including rituximab, bevacizumab and omalizumab. Method: A retrospective observational study was conducted utilizing medical records of 152 patients (19-60 years, median 50 years, 65 men and 87 women) who received rituximab (102 patients) or bevacizumab (42 patients) or omalizumab (8 patients) from January to December 2018 at King Chulalongkorn Memorial Hospital. Results: Total AEs were reported from 59 patients (57.8%) who received rituximab, 32 patients (76.2%) who received bevacizumab and 5 patients (62.5%) who received omalizumab. Very common AEs (more than or equal to 10%) were infections, neutropenia, febrile neutropenia, infusion reactions, disorders of gastrointestinal (GI) system. Most patients (92.9%) in bevacizumab group and almost half of patients (47.0%) in rituximab group had been given chemotherapy concomitantly. Nonetheless, AEs were also reported from the patients receiving rituximab (15.3%) without concomitantly chemotherapies. Moreover, common (more than or equal to 1% but less than 10%) serious AEs were observed in patients receiving rituximab and bevacizumab including GI perforation, pneumonia, cardiovascular events, viremia, septicemia, hydrocephalus, thrombosis with pulmonary embolism, pancytopenia; and severe neutropenia and thrombocytopenia. Conclusion: The incidences of AEs from patients receiving rituximab, bevacizumab and omalizumab were more than 50%. The results of this will assist multidisciplinary team involving MAb therapy to be more vigilant in surveillance the very common AEs and common serious AEs of the MAb drugs.


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