PGY2 Oncology Pharmacy Resident UC Davis Health Fremont, California, United States
Poster Abstract:
Background: Infusion reactions are a common adverse reaction to monoclonal antibody (MAB) treatment. Symptoms include, but are not limited to, chills/rigors, fever, hypotension, and anaphylaxis. The rigors reaction is believed to be mediated by multiple receptors, including mu-receptors, for which opioids are typically used as treatment. At many institutions, meperidine is the agent of choice for this reaction. However, there is minimal published data exploring the efficacy of alternative opioids, such as morphine, in the treatment of MAB-related infusion reaction. Furthermore, there are no published reports comparing morphine to meperidine for this indication. At UC Davis Health (UCDH), due to formulary restrictions, meperidine was removed from all inpatient and outpatient units in early 2023. Morphine is now the formulary choice and included in all MAB order sets for the treatment of rigors related to infusion reactions.
Objectives: This project aims to assess the efficacy and tolerability of morphine compared to meperidine for the treatment of rigors associated with MAB infusion reactions.
Methods: This study is designed as a retrospective, single-center, non-randomized chart review at UCDH. Adult patients treated either in outpatient infusion centers or inpatient units who received one or more doses of IV morphine or IV meperidine for MAB-related infusion reactions were included. Patients will be assessed from January 2015 to January 2024. Baseline characteristics include age, sex, history of opioid allergies, diagnosis, reaction within first two doses of MAB, and reduced renal function at time of administration. The primary endpoint is defined as the number of meperidine or morphine doses required to abort the rigors reaction, and the secondary endpoints include naloxone administration and documented patient sedation within the electronic medical record. Continuous variables will be assessed with the Mann-Whitney U test and categorical variables will be assessed with Chi-square or Fisher’s exact test.
Results: Pending
Discussion/conclusion: Pending
References (must also be included in final poster): Rombouts MD, et al., Systematic Review on Infusion Reactions to and Infusion Rate of Monoclonal Antibodies Used in Cancer Treatment. Anticancer Res. 2020;40(3):1201-1218.
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