2019 年 45 巻 7 号 p. 396-403
Since infusion reaction (IR) frequently occurs in rituximab (RTX) therapy, premedication of antipyretic analgesics and histamine 1 (H1) receptor antagonists before RTX administration is essential. However, there are no standard drugs for H1 receptor antagonists. There is a possibility that H1 receptor antagonists with various pharmacokinetic properties have different preventive/suppressive effects against IR. In this study, we conducted a retrospective study on patients who received RTX first dose with premedication of fexofenadine (n = 31) or bepotastine (n = 33), the second generation H1 receptor antagonist, to compare the inhibitory effects of both drugs on IR occurrence. The incidence of IR was 58.1％ in the fexofenadine-administered group and 21.2％ in the bepotastine-administered group with a significant difference. The IR occurrence time (median) was 65 min after RTX administration in both groups. Multivariate logistic regression analysis indicated that the fexofenadine-administered group is an independent risk factor to increase the risk of IR occurrence by 8.3 times compared with the bepotastine-administered group. Since fexofenadine takes a longer time to reach maximum blood concentration (Tmax) than bepotastine, it is considered that the different effect on IR prevention in both drugs may be caused by the difference in Tmax. Based on these results, it was suggested that H1 receptor antagonists to be administered before RTX administration should be selected taking their pharmacokinetic properties into consideration.