INFORMATION SHEET

Drugs for arthritis: Rituximab

What is rituximab?

Rituximab (trade name MabThera) is one of the newer “biological” drugs. It is a type of drug known as a monoclonal antibody and, more specifically, it depletes B cells, which are involved in the development of an immune response and which are precursors to the cells which make antibodies.

How does it work?

In health the immune system produces antibodies and immune cells to attack organisms such as viruses and bacteria. In autoimmune conditions such as lupus there is abnormal activity of the immune system. Cells known as B lymphocytes are involved in the production of antibodies that bind to targets such as DNA. This is part of the process that results in the disease. Rituximab binds specifically to the B cells resulting in their depletion for a period of months.

Why am I being prescribed rituximab?

Rituximab can be used where disease is severe and has not responded to other more conventional treatments. At present it is licensed for use in a disease called non-Hodgkins lymphoma, but may be used at the discretion of your consultant for other diseases such as rheumatoid arthritis, systemic lupus erythematosus, forms of vasculitis or inflammatory muscle disease.

Rituximab will not be prescribed if:

• your disease is not active
• you have not tried standard treatments first (except in clinical trials)
• you are pregnant or breastfeeding

Your doctor may decide not to prescribe rituximab if you have a history of heart disease.

When and how do I take rituximab?

Rituximab is given by intravenous infusion (that is, through a drip into a vein) on two occasions. You will need to go in to hospital, for a few hours, on both occasions and the second is normally two weeks after the first. You will be given medicines to prevent or reduce fever or allergy prior to each infusion and then the drug infusion is given over about two hours.

How long will ritximab take to work?

The response to rituximab is often evident only after about 6 weeks. The effect of rituximab lasts for a variable period between six and greater than eighteen months, after which symptoms of the underlying condition may recur. Your suitability to receive repeated courses of rituximab will be determined by your consultant.

What are the possible side effects?

Within the first two hours of the infusion you may develop fever, chills and shivering. Other side effects uncommonly seen during infusion are itching of your skin, sickness, tiredness, headache, breathing difficulties, sensation of the tongue or throat swelling, itchy, runny nose, flushing and irregular heart rate. Pre existing conditions such as angina or congestive heart failure may get worse. The frequency of these reactions decreases during subsequent infusions. Rituximab may rarely also cause abnormalities of your blood and affect liver function. There is a theoretical risk of increased infections after rituximab but this is very unusual in practice.

Other undesirable effects have been recorded after administration of rituximab. Most are mild and serious complications are fortunately rare. However, the adverse effects recorded include: pain in muscles and joints, pain at the infusion site, anxiety, dizziness, tingling or numbness in hands or feet, sweating, abnormal taste, cough, reactivation of viral infection (e.g. cold sores), heart failure, heart attack.

Despite this list of side-effects, over half a million patients worldwide have received rituximab an serious side-effects have been rare. For the great majority of patients, rituximab is safe and well-tolerated.

Do I need any special checks while on rituximab?

You will have a physical examination and blood tests prior to treatment and then further monitoring blood tests after treatment.

Can I take other medicines along with rituximab?

You should discuss any new medications with your doctor before starting them, and you should also tell any other doctor treating you that you are taking rituximab.

Do not take ‘over-the-counter’ preparations without first discussing it with your doctor, rheumatology nurse or pharmacist.

Can I have immunisations while on rituximab?

Yearly flu vaccines and pneumovax are safe and recommended and, if not up to date with these vaccinations, it is desirable that they are given two weeks before treatment with rituximab. Live vaccines should be avoided. For more information consult the Cambridge Arthritis Research Endeavour website (www.cambridge-arthritis.org.uk/vaccines.php).

May I drink alcohol while taking rituximab?

Yes

What if I am thinking of getting pregnant?

No one knows the risk of rituximab to an unborn baby. Women of child-bearing age must use contraception while on rituximab. Do not take rituximab if you are thinking of becoming pregnant in the near future or if you are not using contraception.

Since it is unknown whether rituximab would harm an unborn baby, it is also unknown whether it is safe to try for a baby shortly after having rituximab treatment. For female patients, we would generally recommend a gap of 12 months between having rituximab and trying for a baby.

And what about breastfeeding?

Do not breastfeed while on rituximab. It is not yet known whether rituximab could pass into the breast milk and no one knows the risk to the baby.

Where can I obtain further information?

If you would like any further information about rituximab, or if you have any concerns about your treatment, you should discuss this with your consultant, rheumatology nurse or pharmacist.

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