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