Simon Rule, MD, Plymouth University Medical School, discusses how subcutaneous rituximab has impacted clinical practice.
In my own hospital, we’ve been using subcutaneous rituximab for quite a few years now. We did the early studies, and it’s made a massive difference, not just with respect to your day unit, your nursing resource, the chair time, but also with respect to the patients.
So, we did a time-and-motion study, which was published some time ago, comparing intravenous with subcutaneous. We actually timed patients from the minute they walked in the hospital door to the time they walked out.
Whilst on the face of it, an [intravenous] infusion is 90 minutes, the patient’s actually in the hospital for nearly 4 horus by the time they’re in and out. With a subcutaneous, you literally can give and go. You don’t have to give any prophylaxis. So the patient has the injection, it takes about 5 minutes, and they can leave. So that’s a big, big difference. It’s a fixed syringe, so you don’t have to preorder it.
You can give it outside the hospital setting, of course, and the big difference we saw is maybe not so much for the patient but for the relative; because these patients are often elderly, they’ve got their son or daughter taking off work to go to the hospital. If it only takes half an hour rather than all afternoon, then that’s a big, big impact. I think that’s often not looked at particularly. We just focus on how long the patient’s in the chair getting the drug for, but actually, it’s a big impact.