Rituxan failure? | Arthritis Information
I started Rituxan at the end of February and got my second dose mid-March. I felt pretty good from about the end of April to the end of May, but I've been in a flare since then. I saw my RD today and she said that it isn't a long enough time to do it again, so she's going to take me off of Rituxan. Has anyone else "failed" on this drug? I'm just starting to feel like maybe I don't have RA because the meds have been so poor for me. Now she wants me back on prednisone (which I hate) and to try methotrexate again. I had good results with it 7 years ago, until it started making me extremely nauseated for days on end (even the injectible) so I'm not looking forward to doing it again.
I'm not even sure what I want you all to tell me... maybe just that I'm not alone?
Your RD is wrong. This drug can take several rounds to build in your system...it can also take up to 16 weeks to kick in or longer. I know Lynn49 here was at the six month mark of the first round when her kick in happened.
My experience of first round is similar to yours...it took 9 weeks to kick, I had five good ones and then I flared. Second round here I am still waiting for the kick in and am told that it is a 98% chance it will do so.
Like you, my RA is aggressive and drug resistent and not everyone with Rituxan get's that first round miracle of their lives back instantly.
you really should try the second set of infusions before giving up especially if you have had multiple previous failures. I know I did much better after the second set than I did with the first. Now you do probably need something for the intervening time period. If the mtx makes you sick have you tried arava? Or maybe just try a pred pack and see if that will stop the flareSo, how soon could I do a second round? Is there a minimum interval? And do you have any thoughts on how to convince the doc? I'm currently on Arava. Now she's adding the MTX and prednisone as well.
If you find meds that work for you right away and keep working for you, then I think you're in the minority around here...so you're definitely not alone. It sounds like you did have some improvement from the Rituxan, so I would give it more time and get the next round of infusions. I waited 6 months after my first round of Rituxan, but had zero improvement, so I moved on.
Buckeye has a good suggestion about replacing the methotrexate. I personally found Arava to have a lot of side effects for me, but Imuran is another alternative.
Hang in there...the waiting is the hardest part.InnerGlow,
Thanks. I wasn't expecting a "right away" (been at this for 10 years). I guess I just put so much hope into rituxan that to have her tell me today that it probably wasn't going to work really got me down. It seemed like I had only heard about successes with it.
I had two Rituxin infusions in November 2007. There was no immediate improvement, though I thought I felt
slightly better after a couple weeks. But then my life turned upside down in December with the illness and death of my sister, and my own problems with surgical repair of an Achilles tendon rupture (caused by RA) and subsequent MRSA infection that took weeks of IV antibiotics and months of recuperation (and I'm still waiting for the incision to be completely healed - slow healing being another RA joy). Consequently, I don't know if the stress I've been under prevented the Rituxin from being effective or not...?
I'm scheduled for a second round of Rituxin infusions in about a week. I'm encouraged by reading here that others have had better luck with subsequent infusions!
the infusions can be given 6 months apart. I would simply tell your doctor you are willing to try another cycle especially since she has changed your other medications and the fact you did see a response from the drug even if it wasn't for the entire cycle
6xmum, in the States you can have them 3 monthly I believe, our system doesn't do that. You have to be careful though, as too much too quickly can collapse your immune system.
I know how disappointing this can be, I think I reached my deepest darkest depression point with that first round working and then the flare...I am not even sure if I have recovered from the disappointment yet. So much of our lives is relying on these drugs doing the job. Rituxan was 'sold' to me as the drug that 'would give me my life back'. When it doesn't, the disappointment is overwhelming.
You really need to take a few days for yourself and think honestly about what you want to do in this process...try and be gentle on you while you do so.
Perhaps your Rd isn't aware of the latest research that says that the second round of Rituxan infusions can be even more effective. I certainly thought that I was a Rituxan failure. It took me a little more than 6 months to feel anything.
I also think that you need to take some time and think about what you want to do. And, I like to point out that I know several other Rituxan users who were retreated at 4 and 5 months.
Patients with active
rheumatoid arthritis (RA) can continue to safely take courses of anti-B cell drug rituximab even if they did not initially respond to the treatment, new research has indicated.
Researchers from Canada published the results of their study in the journal Arthritis and Rheumatism.
The team's trial involved 1,039 RA patients who received one or more courses of rituximab, which works by knocking out the body's white blood cells called B cells.
Of these people, 570 received two courses, 190 patients needed three and 40 took four courses of rituximab. All these patients had failed to respond to the first course of treatment.
The team found that improvements were seen in the patients who received the additional treatments and that there were no more adverse events in these groups than in people who only took the drug once.
Lynn492008-06-23 18:01:59Thanks for this information, Lynn, if you are on Rituxan it is really good to know.
You're welcome :) Just glad I could help.Thanks, Lynn
When I go back, I'll take a copy of that with me!
One really weird thing for me, is that each time I get a cortizone injection after having had rituxan. They work majic.
I have had Rituxan for RA twice. Once in April 2007 and again in Feb. 2008.
It took 6-8 weeks to start feeling the effect and a full 6 months to get the maximum.
It took my sed rate from 93 to 19. But, it then started to creep up into the 30s. So I took it again in Feb. In March my sed rate was 40 (it hadn't kicked in yet), but by May it was 29. I'm hoping for a better number this month.
There have been some studies that repeat much sooner until they get results.
The jury is still out on retreatment. Since I started relapsing after one month at full effect my current plan is to get more in August. I guess if my sed rate is really low we might wait, but if it is on the upper end I'll just take more.
When I took rituxan with chemotherapy, I got about 2.5 years of relief. I'm hoping I get that again at some point. That was 6 infusions of 730mg. One infusion every 3 weeks.
You can definately take more and sooner than 6 months.
If you don't have other good options, I would repeat it.
Judy
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