What is a Rituximab?

Rituximab (available as Mabthera/ Reditux/ Rituxan) is a drug belonging to the ‘biologics/ monoclonal antibody’ group. It attaches to CD-20, a protein present on the B cells (One of the immune system cells). Once attached, the B cells are destroyed by the immune system. These B cells are responsible for production of the harmful autoantibodies including the rheumatoid factor in rheumatoid arthritis.

When is Rituximab used in Rheumatoid arthritis?

One is advised Rituximab if the disease is not controlled with the basic disease modifying agents (Methotrexate/ leflunomide/ sulphasalazine/ hydroxychloroquine) or if one does not tolerate these medicines. They are also considered if you fail to improve with anti-TNF agents.

How is Rituximab given?

Rituximab is given as an intravenous infusion. It is given in an ICU. For rheumatoid arthritis, you would be given two doses of rituximab two weeks apart.

Before you take Rituximab, inform your doctor about—

If you have had hepatitis in the past. Your doctor will have to rule out any active hepatitis before giving rituximab***.
If you have high blood pressure & are on medications for the same. The medicines have to be stopped 12 hours before the infusion as blood pressure may drop during the infusion.
If you have any heart disease (angina/ heart failure/ palpitations).
If you have any ongoing infection/ have had recurrent infections.
If you are suffering from Tuberculosis.
If you have to take any vaccinations in the near future. Live vaccines cannot be taken when on rituximab therapy.

Can I plan pregnancy when on Rituximab?

No. The safety of rituximab in pregnancy is not proven. Do not plan pregnancy when on rituximab. Rituximab crosses the placenta & can harm your unborn baby. It is recommended to wait for 1 year after the last dose of rituximab before planning pregnancy.

Can I breast feed my baby when on Rituximab?

No. Rituximab is secreted in breast milk & can harm your baby.

What are the side effects of Rituximab?

Infusion reaction- A few patients do experience infusion reactions in the form of chills, shivering, fever, headache, difficulty in breathing.
Patients on Rituximab are at a higher risk of infections as it suppresses the immunity.

Can I consume alcohol while on Rituximab?

You may consume Infliximab while on Rituximab. However, if you are also on Methotrexate, alcohol is better avoided.

How useful is Rituximab in Rheumatoid arthritis?

Clinical trials have shown a significant improvement in joint pain/ swelling & the radiological progression of rheumatoid arthritis with Rituximab. *.,***

Emery P, Fleischmann R, Filipowicz-Sosnowska A, Schechtman J, Szczepanski L,Kavanaugh A et al. The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: Results of a phase IIb doubleblind, placebo-controlled, dose-ranging trial (DANCER). Arthritis Rheum 2006;54:1390-1400.)
**Cohen S, Emery P, Greenwald M, Dougados M, Furie R, Genovese M et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy.Arthritis Rheum 2006; 54:2739-2806.

***Hamaki T, Kami M, Kusumi E, Ueyama J, Miyakoshi S, Morinaga S et al. Prophylaxis of hepatitis B reactivation using lamivudine in a patient receiving rituximab. Am J Hematol 2001; 68:292-294

Trials of rituximab in Rheumatoid arthritis:
DANCER Trial
REFLEX Trial
 

Created on: April 2007

Last updated on: April 2011