Rituximab

Rituximab is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA) and granulomatosis with polyangiitis (GPA, also known as Wegener’s Granulomatosis).

For RA, rituximab is used in combination with methotrexate (MTX). Rituximab is generally reserved for treatment of RA that has not responded to other biologic medications (e.g., tumor necrosis factor (TNF) blocking agents). Rituximab is used in combination with steroids to treat GPA.

Rituximab is given by infusion.

Rituximab requires only two infusions, scheduled two weeks apart. The dose given is 1,000 mg with each infusion. Infusions are given with an intravenous steroid, such as methylprednisolone (Solumedrol®). Your health-care provider may also recommend taking acetaminophen and an antihistamine (e.g., diphenhydramine) before the infusion. These medications will help prevent infusion reactions.

Repeat infusions of rituximab can be given every six months based on treatment response and the activity of your arthritis.

Each infusion can take from four to six hours in length.

As with all of the biologics, you may not feel the effects of the rituximab right away. Some people begin to feel the effects of the medication fairly quickly; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for rituximab to take effect, your health-care provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Rituximab can make it more difficult for your body to fight infections. Therefore, people with active infections should not take rituximab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your health-care provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of rituximab with their health-care provider. 

Also contact your health-care provider if you are having surgery as you may need to stop rituximab until you are healed and there is no sign of infection.

Rituximab has not been studied in pregnant women or nursing mothers so its effect(s) on pregnant women or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Women of childbearing age should use effective birth control methods during and for up to 12 months after treatment with rituximab. Because of the potential for adverse reactions in nursing infants, a decision should be made on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the mother.

If you have ever had a rare infection of the brain called progressive multifocal leukoencephalopathy (PML) or if you have had a previous allergic reaction to rituximab you should not take the medication.

In rare cases, severe skin reactions have been reported in patients receiving rituximab. Get medical help right away if you have signs of redness, swelling, blistering or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.

Rituximab has been associated with abnormal heart rhythms. Tell your doctor if you have any such cardiac issues.

All patients should have a blood test to check for hepatitis B before starting rituximab.

Ideally, your vaccinations should be up to date prior to starting ritxuimab. If you have already started therapy with rituximab, your health-care provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking rituximab, you should speak with your health-care provider.

Like all medications, taking rituximab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from rituximab. When monitored properly the vast majority of side effects are rare, most improve over time and are reversible.

Firstly, rituximab can increase your risk of infections.

Rituximab commonly causes an allergic reaction during the infusion (flushing, itching, changes in heart rate and blood pressure, etc.). A health-care professional will monitor for this reaction during the infusion. 

In rare cases, some people experience headaches, nausea, abdominal pain and diarrhea with rituximab. If any of these symptoms become severe please consult your health-care provider.

Also in rare occurrences, rituximab can cause a drop in blood counts and/or cause problems with the kidneys, bowels, heart and lungs. Your health-care provider will monitor for these effects.

Rituximab can reduce your body’s response to vaccines and timing of vaccine administration and rituximab dosing may an be important consideration. It is best to administer all your necessary vaccinations prior to starting rituximab. Speak with your doctor about when it is best to administer vaccines if you are currently being treated with rituximab.

Take rituximab as prescribed and contact your health-care provider if you have any concerns while taking the medication.

Your health-care provider will recommend taking medications prior to your infusion to help prevent infusion reactions.

Your health-care provider may order periodic blood tests to check your blood counts and to follow the activity of your arthritis.