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Rituximab

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Rituximab, Rituxan

  • See Also
  1. CD20 Monoclonal Antibody
  2. Monoclonal Antibody-Mediated Chemotherapy
  • Indications
  1. Leukemia and Lymphoma
    1. Non-Hodgkin's Lymphoma
    2. Large B cell Lymphoma
    3. Burkitt Lymphoma
    4. Chronic Lymphocytic Leukemia
    5. Acute Mature B Cell Leukemia
  2. Rheumatic Conditions
    1. Refractory Rheumatoid Arthritis
    2. ANCA Vasculitis
    3. Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis)
  • Contraindications
  1. Do not use with live virus Vaccines
    1. Update passive Vaccinations at least 4 weeks before starting Rituximab
  2. Hepatitis B Virus Infection
  • Mechanism
  1. See Anti-CD20 Monoclonal Antibody
  2. Rituximab is a recombinant human Monoclonal Antibody directed against the CD20 Antigen
  3. Rituximab binds CD20 on the surface of B-Cells
    1. Triggers a cytotoxic immune response
    2. Depletes CD20 positive B Cells
  • Medications
  1. Rituximab (Rituxan)
  2. Rituximab Biosimilar agents
    1. Rituximab-Abbs (Truxima)
    2. Rituximab-Arrx (Riabni)
    3. Rituximab-Pvvr (Ruxience)
  • Dosing
  1. See other references for disease specific dosing protocols
  2. Infuse at initial rate of 50 mg/h
    1. May be advanced as tolerated in 50 mg/h increments every 30 min
    2. Maximum infusion rate 400 mg/h
  3. Premedicate doses
    1. Acetaminophen
    2. Antihistamine
    3. Corticosteroid (e.g. Methylprednisolone 100 mg IV 30 minutes before dose)
  4. Rheumatoid Arthritis
    1. Dose: 1 gram IV every 2 weeks for 2 doses
    2. Administered with Methylprednisolone 100 mg
  5. Non-Hodgkin's Lymphoma or ANCA Vasculitis
    1. Dose: 375 mg/m2 IV weekly for 4 doses
  • Adverse Effects
  1. Severe infusion reactions (black box warning)
    1. Typically follows first infusion within 30-120 minutes (up to 24 hours)
    2. Of associated fatalities, 80% occur with the first infusion
  2. Severe mucocutaneous syndrome (fatal events have occurred)
  3. Progressive Multifocal Leukoencephalopathy
  4. Tumor Lysis Syndrome
  5. Hepatitis B reactivation
  6. Acute Kidney Injury
  7. Cardiac Arrhythmia
  8. Severe cytopenia
  9. Bowel Obstruction and perforation
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters, Pregnancy category X)
    1. Use reliable Contraception
  3. Before Initiating Rituximab
    1. Hepatitis B Virus Testing
    2. Quantitative serum Immunoglobulins
  4. Monitoring
    1. Complete Blood Count (baseline and periodically)
    2. Renal Function tests (periodically)
    3. Electrocardiogram (as needed)
  • Resources
  1. Rituximab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b172773b-3905-4a1c-ad95-bab4b6126563