RItuximab

Question 1

Rituximab MoA

Answer 1

Monoclonal antibody against CD20

Targets and selectively depletes CD20+ B cells

Question 2

Indications for Rituximab

Answer 2

Immunobullous disease:
- PV
- PF
- MMP
- Paraneoplastic pemphigus
- BP
-SLE
-DM
-Chroniv GVHD
- CSVV

Question 3

Dosage of Rituximab?

Answer 3

Variable protocols exist:
- Most common is 1gram administered at week 0 and week 2,
- followed by 500mg maintenance doses at 6 - 12 month intervals.

Question 4

Wash out before conceiving with Rituxiimab?

Answer 4

12 months

Question 5

Rituximab contraindications

Answer 5

Severe Active Infection
Pregnancy
Hypersensitivity, allergy

Cardiac arrythmias
Angina pectoris
Hep B carriers

Question 6

Adverse effects of RItuximab

Answer 6

Infusion reactions
- these can be severe (hypoxia, ARDS, AMI, VF)
- often after the 1st infusion

AKI secondary to tumour lysis syndrome

Infection
- hep B virus reactivation
- JC virus causing Progressive multifocal leukoencephalopathy (demyelinating disease of the brain)

Cutaneous side effects:
- SJS / TEN
- morbilliform drug reactions

Cytopaenia

Anti-drug Abs (unclear relevance)

Question 7

Vaccine advice for a patient with Rituximab

Answer 7

Live vaccines are contraindicated. Should be given at least 4 weeks prior to treatment onset.

Other vaccines, are safe, but efficacy might be reduced

Question 8

Rituximab pregnancy category

Answer 8

Category C

Question 9

Rituximab and breast feeding

Answer 9

Limited data
Avoid

Question 10

How quickly does rituximab work?

Answer 10

B cell depletion within 2 -3 weeks

Symptomatic improvement ~ 3 months

Question 11

Premedications for Rituximab?

Answer 11

Paracetamol
Diphenhydramine

OR Methylpred