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Rituximab (Rituxan)
Available:
10mg/mL solution, 10 and 50 mg vials
Dose:
1,000 mg IV given at
baseline and again in 2 weeks; this cycle is repeated every
6 months if additional doses are to be given
Cost:
$7,000 per dose
Indications:
Currently
indicated for the treatment of rheumatoid arthritis failing
disease modifying drugs and TNF antagonists, but Rituxan is
also being studied for use in other autoimmune diseases,
such as lupus.
Side
effects: Infusion reactions may
include fever, low blood pressure, hives or other skin
reactions, swelling, coughing, wheezing, difficulty
breathing, or less commonly dizziness, drowsiness,
headaches, nausea, or blurred vision. Patients should tell
their provider about any irregular heart rate or chest pain
during infusions. Typically, corticosteroids and
antihistamines are given prior to infusions to significantly
reduce the risk of infusion reactions. Studies have
indicated a slight increased risk of infection while taking
Rituxan, particularly reactivation of Hepatitis B.
Immunizations containing live viruses should not be given to
patients receiving this medication.
Monitoring:
Prior to
receiving Rituxan, screening patients for TB and hepatitis
is advisable. Lab abnormalities associated with this drug
may include increased glucose levels, decreased calcium
levels, or an increase in LDH (an enzyme from the liver). A
blood count should be performed at least every six months or
more frequently if patients are taking other medications
with monitoring requirements. Patients prone to frequent
infections should be monitored carefully.
Important
points to know: The risk and
severity of infusion reactions is much less in patients with
rheumatoid arthritis than in patients with lymphoma, the
setting in which Rituxan was originally used. Subsequent
infusions are typically better tolerated compared with the
first infusion. While used off-label for patients with
refractory lupus, a rare central nervous system disorder
(progressive multifocal leukoencephalopathy) was described
in two patients also receiving Cytoxan . Regardless, the
role of this medication in treating many other autoimmune
diseases is expected to be better defined in the future.
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