Hi All,
I had Rituxan last April and am due to get it again. My rheumy has monitored my sed rate and it is rising. My blood tests are just sed rate, crp, and basic chems and counts.
How is your rheumy deciding when you will be retreated with Rituxan? Is the rheumy monitoring other factors - like immune globulins, peripheral b-cell counts, or something else to make sure that you can safely take more?
Any information you can provide about the decision to treat and retreat (like when, how much, etc.) would be greatly appreciated.
Thanks,
Judy
Judy, I don't think I have heard of this Rituxan. Do you take it by infusions? And how often?
a -nut
Hi Judy -
I can't answer on the Rituxin - but did anybody email you about the lymphoma Q on AF? I tried to site mail you, but the page didn't open so I posted a 'does anybody know how to reach Judy' on the Site Email Thread.
Pip
From what I can understand about Rituxan is that it is given every 6 months unless you are doing well. I would guess the decision to retreat would be made on what your labs look like and how you are presenting clinically (i.e. do you have increased pain, swelling, morning stiffiness etc.). It sounds like your first treatment with Rituxan threw you into remission and now you are coming out of it and need to have the 2 infusions again.
I am about to have my first infusion of Rituxin on the 29th. I will for sure ask about re-treatment with it.
It can be given every three, six or twelve months depending on how you respond as a patient but each country has specific rules and guidelines on it, as it's a very expensive drug.Is this a new drug? This is one I havn't heard much about. Rituaxn sounds like it's a pretty potant drug. Me think's I need to do some research
A-nut
Pip,
That is how I got here. Someone else posted that Laura was looking for other lymphoma patients. I hooked her up with the lymphoma board.
Judy
A-nut,
Rituxan has been used for the treatment of lymphoma in the US since 2000.
It was approved in the US for treatment of RA in 2006.
Since I have had lymphoma and the other drugs (Enbrel, Remicade,...) are linked with increase risk of lymphoma, I have decided to use Rituxan to treat the RA and keep the lymphoma away at the same time.
Judy
Cordelia,
Thanks for the information. You got a great response. That is wonderful. It put me in remission. It took a long time - a full six months, but each month I was better until month six when I was in remission. It only lasted 1 month. But, I am so much better. My sed rate is only a few points above normal the last couple months.
How many 6 month cycles have you had? Have you had any problems with it?
Judy
Grammaskittles,
Best wishes for an easy first infusion. The first one is slow to prevent any reactions. I have been lucky and have had no reactions from it and as far as I know no side effects.
Judy
I have had one round of Rituxan...it's called Mabthera here...I have my second in March.
Mabthera (Rixuximab. Rituxan is the brand name in the US:
A new "biologic" therapy with a unique mechanism of action is proving effective in pushing painful rheumatoid arthritis into remission over the long term, researchers report.
The drug, rituximab (brand name Rituxan), has already proven safe and effective in treating non-Hodgkins lymphomas. But its ability to suppress immune B-cells may make it a valuable new weapon against rheumatoid arthritis as well.
"What rituximab does is give us another tool in our toolbox, particularly for people who have failed other treatments," said Dr. Hayes Wilson, chief of rheumatology at Piedmont Hospital, in Atlanta, and national medical advisor for the Arthritis Foundation.
Wilson was not involved in the study, which appears in the May issue of Arthritis & Rheumatism.
Rheumatoid arthritis is a chronic inflammatory autoimmune disease, in which the body's immune system attacks joint tissues, causing ongoing stiffness and pain. The exact causes of the disease remain unclear, and treatment effectiveness varies widely from patient to patient.
Many rheumatoid arthritis drugs are aimed at suppressing inflammatory T-cells, but experts say that less than half of patients respond to these therapies. Rituximab works on a wholly different mechanism, selectively depleting another immune-system player, the B-cell.
"That's important, because one of the cardinal signs of rheumatoid arthritis is what we call a 'positive rheumatoid factor,' " Wilson explained.
Rheumatoid factor is a kind of antibody long associated with severe rheumatoid arthritis. While most people have a rheumatoid factor level of well under 100, that number can soar in patients affected by the joint disease. "I have a cousin, for instance, who the very first time I saw him had a rheumatoid factor of 853," Wilson said. "He had really diffuse disease in every finger of his hands and every toe."
The key to rituximab's effectiveness is that it depletes B-cells, the major source of antibodies such as rheumatoid factor.
In the study, which was funded by drug makers Genentech, Biogen Idec and Hoffman-La Roche, researchers in Europe and the <st1:country-region w:st="on">United States</st1:country-region> followed the six-month outcomes of 465 rheumatoid arthritis patients receiving either rituximab by infusion or a placebo. All of the patients had shown little response to other treatments.
The patients received two infusions two weeks apart of either 1,000 or 500 milligrams of rituximab, along with intravenous or oral steroids, or a placebo. All participants also received a standard therapy, methotrexate. Doctors checked the patients' progress every four weeks for a total of six months.
The study "confirmed the efficacy of rituximab," said lead researcher Dr. Paul Emery, professor of rheumatology and head of the Academic Unit of Musculoskeletal Disease at Leeds Teaching Hospitals Trust in Leeds, <st1:country-region w:st="on">England</st1:country-region>.
Based on a standard 28-joint assessment of swelling and tenderness, about 55 percent of these tough-to-treat patients achieved real disease improvement after taking rituximab. That compared to just 28 percent of patients taking methotrexate plus a placebo.
Furthermore, rituximab worked just as well at a lower dose as it did at the higher dose. It also didn't seem to make a difference whether patients took long-term steroids along with their rituximab or not.
"Steroids are given along with the medicine to help your body accept this new protein that's coming into the body," Wilson explained. They are also given to help ease arthritic symptoms.
But the study found that patients taking rituximab didn't gain any added benefit from steroids, beyond the dose given at the time of the infusion. That's good news, Emery said, because "there are multiple side effects of steroids, mainly due to cumulative long-term effects rather than short-term actions."
According to Wilson, these heartening results open a new window for patients battling this crippling disease. "This is like everything else in medicine -- if you have something that is very difficult to treat, you want to have as many alternatives as possible," he said.
Wilson likened the doctor's job to a mechanic's as he works on a car: The more tools he has at hand, the better. "If you can have an extra wrench that can help you get deep inside the engine, that's great. And what rituximab can do is go deep inside the immune system and target this one specific nut or bolt -- a specific type of inflammatory cell, the B-cell."
He cautioned, however, that many rheumatologists may wait to use rituximab until its true worth has been proven in a much larger, controlled clinical trial.
That day may come soon, however. According to Emery, "longer trials are planned to optimize the use of this very interesting drug."
Thanks cordelia.
No problem, glad to help.
I just had my first two rounds, bc I had a reaction, throat swelling, they had to slow down my infusion so it took over 8 hrs!!! for the first one and 6 for the 2nd that was January 4th.
They gave me benadryl, plus i took one valium, i really just wanted to sleep thru it! Except, lol, i was snoring soo loud, that one of the patients in the room had to ask for headphones, and um they could also hear me way down the hall.. LOL
I actually felt better after, bc they give a large dose of steroids, w/ it.. tho after the 2nd one,,3 days later, i came down w/ the flu and here i am almost 3 wks later, still w/ it.. but i think almost over.
I had a great nurse, they check your bp and temp, constantly..mine flucatated widely from 96.1 to 98.8 ( my norm temp is 96 or 97) 98 is a fever for me. Actualy it was pretty easy, they were giving to me, bc I didn't respond well to the Humira and I do think its already made a bit of difference, of course, i've been too sick to notice, lol.
I'm a bit concerned w/ the lack of long term results, but sigh, you gotta do , what you gotta do.. shrug
Whispered,