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Rituximab (Rituxan and MabThera) is a drug used to treat rheumatoid arthritis that has not improved with other types of medications, as well as certain forms of vasculitis. It works by turning off a part of the immune system that is not working properly in autoimmune diseases.
Rituximab is used in combination with methotrexate to treat RA that has not responded to one or more types of treatment, including anti-tumor necrosis factor (TNF) blockers. Rituximab also is used to treat certain types of vasculitis (an inflammatory condition affecting blood vessels), such as granulomatosis with polyangitis or MPA. Occasionally rituximab is used to treat other immune problems, including autoimmune blood disorders, lupus, and inflammatory muscle diseases. Rituximab also is used in the treatment of some blood disorders, including chronic lymphocytic leukemia and non-Hodgkin’s lymphoma.
Rituximab targets a protein on B cells, which are part of the immune system (the body’s defense against infections and other harmful substances). B cells produce antibodies, proteins that allow the body to remove infectious or other dangerous particles. B cells also produce chemicals that help other parts of the immune system do their jobs. However, people with rheumatoid arthritis and vasculitis make B cells that do not work the way they should. These abnormal B cells do not interact properly with other parts of the immune system and can attack a person’s own body even if there is no infection (which is called an autoimmune response).
The autoimmune response can result in a number of different symptoms, including inflammation of the joints (arthritis), with symptoms of joint pain, swelling and stiffness. The autoimmune response can also affect blood vessels and cause inflammation, resulting in multiple problems in many parts of the body, including the skin, sinuses, lungs, and kidney. By temporarily removing the harmful B cells, rituximab can help control the arthritis, and can help control inflammation of blood vessels.
Rituximab is given as an intravenous infusion (IV or “drip”) into a vein. The infusion usually takes 2 – 4 hours, although occasionally it can take longer. A course of rituximab for rheumatoid arthritis usually consists of two 1000-milligram doses given 15 days apart. To treat vasculitis, a smaller dose is given once a week for 4 weeks in a row.
The effects of rituximab begin about 6 weeks after the infusions. Usually by the third month, the full effect occurs, and can last up to 9 months.
Sometimes patients’ blood pressure can drop during the treatment. Those who take medication to lower their blood pressure may have to stop it before the infusion.
Some patients feel mild side effects during or up to 24 hours after receiving rituximab. These usually occur with the first infusion, and can include mild throat tightening, flu-like symptoms, rash, itchiness, dizziness and back pain. These symptoms can be reduced by receiving a steroid injection before the infusion, along with acetaminophen (Tylenol) and diphenhydramine (Benadryl). The infusion is sometimes stopped for a short while and then restarted at a slower rate if the symptoms get better. Rarely, patients will have more serious symptoms, such as wheezing, mouth or throat swelling, trouble breathing or chest pain. Patients who experience these symptoms should tell their health care providers immediately; patients may receive stronger medications to treat those symptoms.
Other side effects around the time of the infusion can include headache, cough, nausea, upset stomach, sweating, nervousness, muscle stiffness, and numbness. Patients can take mild pain medications, such as acetaminophen, for them, but should call their doctors if the symptoms are severe or get worse.
In the months after the treatment, some people may notice more frequent infections, such as colds or sinusitis. Usually, these are not severe. There are a few rare but serious side effects from rituximab. These include severe skin reactions and mouth sores. Patients who experience vision changes, loss of balance, difficulty walking or confusion should contact their doctors immediately.
Biologic drugs [including etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), certolizumab (Cimzia), golimumab (Simponi), abatacept (Orencia), and tocilizumab (Actemra)] may increase the risk of serious infections and medication side effects. Blood pressure medications may increase the risk of low blood pressure during the infusion.
Updated March 2015 by S. Monrad, MD and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.
© 2015 American College of Rheumatology