RITUXIMAB
Rituximab is a
chimeric monoclonal antibody biologic agent that targets CD20 B lymphocytes .
This depletion takes place through cell-mediated and complement-dependent
cytotoxic-ity and stimulation of cell apoptosis. Depletion of B lymphocytes
reduces inflammation by decreasing the presentation of antigens to T
lymphocytes and inhibiting the secretion of proinflammatory cytokines.
Rituximab rapidly depletes peripheral B cells, although this depletion
correlates neither with efficacy nor with toxicity.
Rituximab is given as
two intravenous infusions of 1000 mg, separated by 2 weeks. It may be repeated
every 6–9 months, as needed. Repeated courses remain effective. Pretreatment
with intravenous glucocorticoids given 30 minutes prior to infusion (usually
100 mg of methylprednisolone) decreases the incidence and severity of infusion
reactions.
Rituximab is indicated
for the treatment of moderately to severely active rheumatoid arthritis in
combination with methotrexate in patients with an inadequate response to one or
more TNF-α
antagonists.
About
30% of patients develop rash with the first 1000 mg treat-ment; this incidence
decreases to about 10% with the second infusion and progressively decreases
with each course of therapy thereafter. These rashes do not usually require
discontinuation of therapy but of course an urticarial or anaphylactoid
reaction pre-cludes further therapy. Immunoglobulins (particularly IgG and IgM)
may decrease with repeated courses of therapy and infections can occur,
although they do not seem directly associated with the decreases in
immunoglobulins. Rituximab has not been associated with either activation of
tuberculosis or the occurrence of lympho-mas or other tumors . Other adverse
effects, like cardiovascular events, are rare.
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