Rituximab FOR NEUROLOGICAL DISORDERS
What is rituximab?
Rituximab is a new drug that removes certain cells, called B-cells, from your body. In healthy people, B-cells make antibodies that help fight off germs and viruses. However, in people with certain neurological diseases, the B-cells become confused and start producing harmful substances called autoantibodies instead which start to attak your own healthy cells.
How does rituximab work?
Rituximab attaches itself to B-cells and destroys them. By doing this, it helps to stop your immune system from producing cells, both the antibodies and the autoantibodies. This might make it harder for you to fight off infections. Rituximab will destroy some of your healthy B-cells, but these will return after a few months.
What should I tell my doctor before receiving rituximab?
Tell your doctor if you have had any of the following:
When do I take rituximab?
Usually, you will start off with 2 doses of rituximab, with a 2 week break in between. You might get another dose 6 to 9 months later if your condition doesn’t seem to get better. Your neurologist will depend on you, to some extent, to say when you are having trouble again. You should discuss this in advance with your neurologist
How do I take rituximab?
Rituximab is given by intravenous infusion (IV drip) in a hospital clinic. A needle will be put into a vein in your hand or arm to give you the drug. Half an hour before you start your IV drip, you will be given Tylenol so you don’t get a fever, Benadryl, an anti-allergy medicine, and Solu-medrol which is a medicine that reduces your immune response. These drugs help prevent any reactions you might have to rituximab.
You should plan to stay at the clinic for 6 – 8 hours.
Because some of the drugs you will be given can make you dizzy or sleepy, you should arrange for someone else to drive you home after each treatment.
When you are receiving rituximab treatments, you should carry information about the treatment you received with you. This is because if you get sick, the people treating you will know that you have received rituximab and that your B-cell count may be low. You can get the information you need to carry from your doctor or nurse.
How long will rituximab take to work?
It takes a few weeks to see improvements after your treatment with rituximab. It is usually clear by three months whether or not rituximab will help you.
What are other things your doctor needs to know while you’re on rituximab?
Your doctor needs to know if you:
You might get infections more often after the treatment because your immune system will be low. If you have a fever or any other symptom of infection, you should call your neurologist, family doctor or nurse.
After 3 doses of rituximab, you might have fewer healthy B-cells as well as unhealthy ones. Since the healthy B-cells help fight infection, your risk of infection might be higher.
If you develop any other new symptoms after starting rituximab, see your neurologist as soon as possible. If any of these symptoms are severe, see a doctor immediately. If you can’t see your neurologist, go to the emergency room at the closest hospital to you.
What are the possible side effects during the IV drip?
The most common side effects of rituximab treatments are reactions to the IV drip. These are most likely to occur during the first IV drip. Most of these reactions are not severe and include:
If you develop any symptoms during the IV drip, you should tell the person giving you the treatment right away, because they might have to slow down the IV drip. Very rarely, reactions are severe enough to stop the treatment.
What are the side effects I may experience at home?
The more common side effects you might have are:
You could have the more serious side effects of severe skin and mouth reactions. These are:
Tell your doctor or get medical help right away if you get any of these symptoms at anytime during your treatment with rituximab.
Rarely, rituximab can cause serious and life-threatening side effects.
If you have had Hepatitis B in the past, rituximab can cause the virus to become active again. This can cause serious liver problems. Watch out for:
Another side effect can be heart problems. Watch out for:
You might develop kidney problems that make it harder for your body to make urine.
You could have stomach and serious bowel problems including blockage or tears in your bowel.
Rituximab can cause changes in your blood. You may have a drop in the numbers of:
You could possibly develop Progressive Multifocal Leukoencephalopathy (PML). This is a serious brain infection caused by a virus. This is a very rare side effect but people with a weakened immune system can get PML. PML can result in death or severe disability. There is no known treatment, prevention, or cure for PML.
Tell your doctor right away if you have any of the following symptoms or if anyone close to you notices that:
Your doctor prescribed you rituximab because he or she has judged that the benefit to you is greater than the risk of side effects. Most people using this medication do not have serious side effects.
Do I need special tests while on rituximab?
You should have blood tests before you begin your treatment and every few months after that.
The pre-screening tests we’ve asked you to do help us identify and reduce potential risks.
Can I have vaccinations after a treatment with rituximab?
Discuss all vaccinations with your doctor. Usually, you will need to wait 4 weeks after your treatment to get vaccinated. If you need any vaccinations, you should get them before you start Rituximab or between doses. Talk to your neurologist about this.
Some vaccines are called “live” vaccines. Usually you would be asked not to get vaccines of this kind while you are being treated with rituximab. However, sometimes you may need to have a live vaccine. For example, you may need a rubella (German measles) vaccine if you are a woman of childbearing age. Your doctor will discuss the possible risks and benefits with you.
Pneumovax (a vaccine that is given to protect you against pneumonia) and yearly flu vaccines are safe, but you should ask your neurologist if you should have them.
Does rituximab affect pregnancy?
We don’t know yet if rituximab will hurt your baby if you become pregnant soon after taking this drug. The maker of the drug suggests that you do not get pregnant for 12 months after your treatment. You should take care not to become pregnant after treatment with rituximab unless you have discussed this in detail with your doctor. You should not take rituximab during pregnancy.
What about men taking rituximab and pregnancy?
Please use contraception during your period of treatment and for 12 months after to prevent your partner from becoming pregnant.
What about breastfeeding?
Rituximab enters your breast milk and may affect your baby’s B-cells. You should not take rituximab if you are breastfeeding. You should not breastfeed for 12 months after a dose of rituximab.
When may I return to my usual activities?
You may return to your usual activities once you are at home
Can I travel?
Ask your neurologist if you can travel. Your neurologist can judge if you are well enough to go elsewhere.