rituximab 5/5 (3)

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This page contains a brief description that does not cover the medication. For more information read the review in Felleskatalogen.no for the respective drug.

Definition

Rituximab (rituximab) is the active substance in MabThera and Rixathon who is biological drug which inhibits lymphocytes (a type of white blood cells) by binding to the antigen CD20 which is located on pre-B and mature B-lymphocytes. Treatment is given as an intravenous infusion or syringe (subcutaneously). Rixathon and Truxima are biochemical drugs

Before start of treatment

Vaccines

  • Annual flu vaccine is recommended
  • Pneumococcal vaccine before initiation of treatment (effect lasts for 7-10 years) is recommended
  • Consider hepatitis B vaccine (vulnerable persons)
  • "Live vaccines" should not be used
  • More about vaccines here

Pneumocystis jiroveci prevention

  • Prophylactic (preventive) treatment against Pneumocystis jiroveci by immunosuppressive treatment with, for example, Sendoxan or MabThera
  • If the T cell subpopulation is examined, CD4 T cell numbers below 400 will indicate increased infection risk
    • Bactrim / Trimethoprim Sulfa (either 2 tablets three days a week or 1 tablets daily)
    • NB Interaction with Methotrexate
    • By sulfa allergy can dapsone 50mg x 1 be an option
      • Dapson also contains a sulfa component and allergy is possible
      • An alternative is pentamidine inhalations for example 300mg each month. However, there is an adverse reaction risk that indicates careful follow-up

Dosage

  • Rituximab must be administered intravenously (iv) in hospitals. Dosage in rheumatic disease is most often the case Rheumatoid arthritis (1000mg iv twice at two week intervals), or after "lymphoma protocol": 4 infusions, each dose is 375mg / m2 body surface = approx. 600mg at 1 week intervals
  • First infusion is often given during observation in the ward
  • Often, concomitant treatment with azathioprine (Imurel), mycophenolate (CellCept), methotrexate or similar is stopped following an individual assessment of the disease and the need for treatment.
  • Rituximab is mixed in 500ml NaCl. Before infusion (30-60 min) it is often given Solu-Medrol iv125 mg in 100ml NaCl 9mg / ml, given over 15 min. and Declorpheniramine 5mg iv (or Polaramin 4mg tablets) + paracetamol 1g for better tolerance
  • In maintenance treatment to prevent relapse, the rituximab dose is often lower (500-1000 mg single dose) given as needed or approximately every 4-6. month
  • For infusion rate and further procedure: See the Norwegian "Felleskatalog"
  • How long the treatment should continue must be considered in each case

Prescription

  • H-prescription which is covered by the patient's health care company or the relevant hospital at admission

Doctor Check / monitoring

  • Specialist / Specialist in Rheumatology and General Practitioner
  • Some get decreased levels of Immunoglobulin IgG in blood and reduced immune system (increased risk of infection)
    • Immunoglobulins (IgG) are checked in blood samples
  • CNS (brain) side effect: progressive multifocal leucoencephalopathy (PML) is observed, but unclear relationship with ritual simab. Due to reactivation of latent JC polyoma virus

Measurement of drug effect

  • Measurement of CD19 + B cells (correlated with the number of CD-20 B cells) indicates whether effect om cells is still present.
  • CD19 + B cells stay low 6-12 months after infusion

Patient information

Medications, BINDEVEVSSYKDOMMER.no


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