RITUXIMAB/MABTHERA | Arthritis Information

Hi again guys, I need to know if anyone taking Rituximab/mabthera is not taking Methotrexate with it and if so how are you responding to the drug. Here in Australia the criteria to receive the drug through our government system requires use with Methotrexate. I may not be able to continue the MTX and was wondering if it will work as monotherapy. Thanks in advance for any assistance. Janie. And if I may join in (as someone considering Rituxan and not able to take mtx), are there other medications that work in combined therapy, like Arava or Imuran instead of mtx?

Cordy just had her first infusion of Rituxan. She will be able to answer any questions.

Is this the next step for you Janie?

Yes shelley, this is my last hope for now apparently, inflammatory markers are out of control even with mtx and pred, and I have tried everything else, but I may have to stop MTX due to repeated chest/lung problems. How are you doing? I hope you are keeping well.

Hi Suzanne, I have checked the criteria here in Aus, if you cannot take the 7.5mg required of MTX, then you have to take the alternate therapy of either Humira or Enbrel. Check with your pharmeceutical company. Keep well, hugs Janie.

Hi, I had Rituximab in May I can't have it with MTX as it screwed up my liver so instead had a cyclophosphamide infusion the day before each Rituximab infusion. I had cyclophosphamide in the chemo unit as it is primarily an anti cancer drug. If you have this make sure they give you anti sickness drugs I was sick every half an hour for the few days after the cyclo infusions trust me this was not pleasant. I also had 2 blood transfusions as I was so wiped out.

I was the only patient to have this combination and according to my nurse my blood results showed I had the lowest CD19 count out of all the other rituximab patients (apparantly that is good). Only problem is i don't think it has worked for me my ESR is still 100+ and I am flaring all the time, going to hospital tomorrow so will find out then if the drugs have done anything.

I was told rituximab is not very effective on it's own.

I've attached a link to a sheet on cyclophosphamide.

http://www.arc.org.uk/arthinfo/patpubs/6244/6244.asp

Janie,
I had the infusions with a very low dose of mtx. I had not been on mtx for awhile since I experienced negative side affects. My doctor gave me 2.5 mg tabs and told me to try 2 tabs weekly for a few weeks before the infusions and if I experienced the negative side affects to stop taking them. He did know of some people who had the infusions without the mtx and they were successful. I believe there is a better chance of success if you do take the mtx. For me, I was able to handle the low dose of mtx and continue to take it 8 weeks post infusion.

Pat

I could not take it either. My RD prescribed Cyclosporine as an adjunt to Rituxin. It worked relatively well. But, as usual I developed an allergy to it so had to change yet again. Right now,I am on sulfasalazine and have not really noticed any difference, so am going to ask to stop at next appointmnet. I have been thruough two rounds of Rituxan therapy and am currently doing moderately better.

It does take a few months to act for me, so dont be disappointed if you don't feel better immediately.

Crispy

I take Arava instead of MTX. I will be getting my second cycle of rituxan in a couple of weeks.

I had no side effects with the infusion or medication. I did well for the first 6 weeks then had a flare. I stabalized at the flare level until last week when I began a big time flare. I am interested to see how I do with this next set of infusions

I just read your post LornaUK, re: your cyclophosphamide infusion. I was giving cyclosporine, which is pill form to take 2 times every day. It did not make me sick, perhaps a bit nauseous.

It is used in the US mostly for anti-rejection of organ transplantation. It is a very powerful drug for lowering your immune system. So if on the combination of Rituxan and cyclosporine you must be careful to not get infections.

I don't know of anyone else in the states who has taken the combination either. Please let me know how you are doing. Maybe I missed it but I did not see how long its been since your infusion. Best of luck to you.

Hi Jane, I used to take methotrexate until it affected my liver .since then i have been on arava. and i will stay on arava while on embrel. have you had arava before?Thanks to all of you for replying, sorry I have not been on but not well after my sons fit, it reacted in me a couple of days later. I still have a residual cough and am having a chest CT Scan tomorrow, chest is still making funny noises like a stryder I think they call it and asthma problems. Rheumy wants CT before okaying Rituximab application.

HI Allycat, yes I have been on Arava probably the only drug I tolerated a bit longer than the others, but developed peripheral neuropathy on it which has now reversed. Also had terrible gastro problems, so bad it interfered with my daily life so much so that I could not go out. Anyway just doing as I am told at present, off of MTX, antiinflammatories and Neurontin and not doing too bad so far, wierd isn't it? Mind you I am taking Oxycontin and Endone. I switch them around they seem to work better. Thanks again everyone. Hugs Janie.

Hi Crispy,

Well since the infusions i've been OK, had an appointment last week and my ESR has come down to 86 which is the lowest it has ever been so it has taken effect just slowly, I have also had slighly more energy and less flares which is a good thing.

Talking about infections I have been off work since last Wednesday with flu type symptoms which I can't seem to shift, will go to Dr's tomorrow if not any better

Anyway hope everyone else is feeling well.