Rituximab
Mechanism :
The Fab regions of rituximab binds to the CD20 antigen on B lymphocytes, while the Fc domain recruits antibodies and complements to mediate cell lysis.
Indication :
- Refractory autoimmune hemolytic anemia, chronic ITP, Refractory nephrotic syndrome, Refractory SLE, refractory JIA
- Treatment of relapsed or refractory acute lymphocytic leukemia (ALL) in combination with ifosfamide, etoposide, and carboplatin
- Treatment of acquired blood factor deficiency in hemophilia A
- Treatment of steroid-refractory chronic graft-versus-host disease (GVHD)
Contraindications :
Hypersensitivity; Hypersensitive to murine proteins; Caution in elderly pts; Caution if cardiovascular disease or hx, angina or hx, pulmonary disease, high tumor burden, HBV carrier, infection, latent or chronic.
Dosing :
Treatment of relapsed or refractory acute lymphocytic leukemia (ALL) in combination with
ifosfamide,
etoposide, and carboplatin:
375 mg/m² IV on days 1 and 3 of cycles 1 and 2, and on day 3 only of cycle 3.
Treatment of steroid-refractory chronic graft-versus-host disease (GVHD):
>8 years-15 years:
375 mg/m² IV weekly for 4 weeks followed by maintenance therapy with rituximab 375 mg/m² IV monthly for 4 months.
Refractory autoimmune hemolytic anemia, chronic ITP, Refractory nephrotic syndrome, Refractory SLE, refractory JIA, Treatment of acquired blood factor deficiency in hemophilia A:
375 mg/m² IV once weekly for 2-4 doses.
Adverse Effect :
Serious Reactions: Mucocutaneous reactions including serious rash such as paraneoplastic pemphigus, Stevens-Johnson syndrome, lichenoid dermatitis, vesiculobullous dermatitis, and toxic epidermal necrolysis. Anaphylaxis, angioedema, bronchospasm, cardiogenic shock, flushing, hypotension, hypoxia, myocardial infarction, pulmonary infiltrates, throat irritation, tremor, urticaria, and ventricular fibrillation. Acute respiratory distress syndrome and cytokine release syndrome have also been reported. Hepatitis B virus (HBV) reactivation resulting in hepatitis B exacerbation, fulminant hepatitis, hepatic failure, and death. Progressive multifocal leukoencephalopathy (PML), caused by the JC virus.
Common Reactions: infusion reaction, fever/rigors, lymphopenia, infection, Hypogammaglobulinemia, fatigue/asthenia, nausea/vomiting, hypophosphatemia, headache, muscle spasms, night sweats, pruritus/rash/urticaria, insomnia, abdominal pain, leukopenia, neutropenia, cough, thrombocytopenia, epistaxis, diarrhea, dizziness, arthralgia/myalgia, hypotension, hyperglycemia, anemia, peripheral edema, elevated LDH, hypertension.
Interaction :
Interaction Characteristics:
Immunosuppressive effects.
Contraindicated:
Adenovirus vaccine, live; Influenza nasal vaccine, live; Measles/mumps/rubella vaccine, live; Rotavirus vaccine, live; Smallpox vaccine (live vaccinia virus); Typhoid vaccine, live; Varicella vaccine, live; Yellow fever vaccine, live; Zoster vaccine, live.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Use with caution |
| 10-20 | Use with caution |
| <10 | Use with caution |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Use with caution |
| HD | Not dialysed. Use with caution |
| HDF/High flux | Unlikely to be dialysed. Use with caution |
| CAV/VVHD | Unknown dialysability. Use with caution |
Hepatic Dose :
No dose adjustment recommended.