Class
- Immunosuppressant, immunomodulator, monoclonal antibody
Rituximab
Commonly Prescribed for
(FDA approved in bold)
- B-cell non-Hodgkin lymphoma (NHL)
- Rheumatoid arthritis
- Myasthenia gravis (MG)
- Multiple sclerosis (MS) (relapsing-remitting)
- Multifocal motor neuropathy
- Anti-myelin-associated glycoprotein (MAG) neuropathy
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Neuromyelitis optica
- Dermatomyositis
- Opsoclonus myoclonus
- Sarcoidosis
- Chronic lymphocytic leukemia
- Waldenstrom macroglobulinemia
- Thrombocytopenic purpura
Rituximab
How the Drug Works
- Binds to the CD 20 antigen on pre-B and mature B lymphocytes, inducing apoptosis. The antigen is expressed in greater than 90% of B-cell NHL but not on stem cells, pro-B-cells, plasma cells or normal tissues. B-cells are felt to be important in the pathogenesis of rheumatoid arthritis, MS, MG, and many other autoimmune diseases
- Rituximab may also decrease other biologic markers of inflammation, such as c-reactive protein, serum amyloid protein, and rheumatoid factor
Rituximab
How Long Until It Works
- By 2 weeks, but effect on disease may take months
Rituximab
If It Works
- May allow reduction in dose or discontinuation of steroids or other agents in the treatment of MG, MS, or other neurological conditions
Rituximab
If It Doesn’t Work
- Usually used as an adjunctive agent in conjunction with steroids or other agents in MG, but other agents such as azathioprine, mycophenolate mofetil, and cyclosporine are often used instead. In MS, used as an alternative to other agents for refractory relapsing-remitting patients
Rituximab
Best Augmenting Combos for Partial Response or Treatment-Resistance
- Often combined with prednisone or other steroids for treatment of MG, allowing eventual decrease in dose. Occasionally combined with other immunosuppressive agents for many autoimmune diseases, but AEs may increase
Rituximab
Tests
- Obtain complete blood counts before beginning and during therapy, more frequently if patient develops cytopenia
Adverse Effects (AEs)
Rituximab
How Drug Causes AEs
- Serious AEs are related to infusion reactions, immunosuppression, and lymphopenia
Rituximab
Notable AEs
- Infusion reactions in 32% usually take place with the first infusion and may include fever, chills, angioedema, bronchospasm, or blood pressure changes. Infection (mostly respiratory tract infections) fever, chills, weakness, itching, headache, and dyspepsia
Rituximab
Life-Threatening or Dangerous AEs
- Not uncommon: Severe lymphopenia lasting a few weeks, occurs in about 40% of patients. Neutropenia, leukopenia, and anemia are less common. Reactivation of hepatitis B. Severe mucocutaneous reactions, including Stevens-Johnson syndrome. Severe infection or sepsis. Tumor lysis syndrome
- Rare: JC virus infection leading to progressive multifocal leukoencephalopathy. Bowel obstruction and perforation
Rituximab
Weight Gain
- Unusual
