Anyone have any information on Rituxan? | Arthritis Information
I am looking for information about others experiences with the new drug 'Rituxan'. I have been on Enbrel for 7 years and its now failing me so my Rheumy has requested that I try rituxan but I'm not finding much on arthritis insight about it. Honestly, I'm rather scared. I've considered myself lucky that I could use enbrel with no side effects and I'm uncomfortable pushing that luck button again. I did read that it can cause something called PMI which if you get it, its uncurable and will cause death.
Thank you in advance for any help or reassurance
Julie
Julie,
I use Rituxan and it has worked wonderfully for me. I've had RA for 9 years and this is the first med that has worked. I haven't had any problems with side effects except for a little naseau after the first set of infusions. That lasted for about two weeks.....
I will have gone 15 months without needing an infusion. In that time I've been able to stop using both MTX and prednisone. My sed rate and crp were normal for the first time in 8 years. I have another set of infusions scheduled for the first week in October because my sed rate and crp were elevated (just a bit) and because my ankles were becoming stiif and sore. That is the first place my RA hit, so I decide to go ahead and have another treatment of Rituxan.
I posted this about Rituxan and PML a few days ago........
I'm prettty sure someone will post this and since I use
Rituxan, I thought I would do it first. Let me add that I'm scheduled for my second set of infusions starting the first week in October and this hasn't impacted that decision at all.
| ROCKVILLE, Md., Sept. 11 -- A rheumatoid arthritis patient treated with rituximab (Rituxan) was diagnosed with progressive multifocal leukoencephalopathy (PML) 18 months after taking the last dose of the agent, and later died, the FDA and drugmakers announced today.
It was the first PML-associated death of a patient taking rituximab for RA, according to Genentech and Biogen Idec in a letter to clinicians. The patient, who developed a JC virus infection leading to PML, had been taking the drug in a long-term safety extension clinical study.
"This case was confounded by the patient's development of oropharyngeal cancer, which was treated with chemotherapy (a platinum-containing regimen) and radiation therapy nine months prior to the development of PML," said the letter.
"The patient had longstanding RA treated with immunosuppressants and a complex medical and rheumatologic history including Sjogren's syndrome and undetectable complement C4 levels. Treatment for RA included methotrexate, steroids, and a TNF antagonist prior to Rituxan therapy, and methotrexate and steroids during and after Rituxan therapy."
Rituxan is approved for RA in combination with methotrexate to reduce signs and symptoms and to slow the progression of structural damage in adult patients with moderate to severe active disease who have had an inadequate response to one or more TNF antagonists.
The rituximab label was updated to reflect the PML-associated death.
"Physicians treating patients with Rituxan should consider PML in any patient presenting with new onset neurologic manifestations," said the letter. "Consultation with a neurologist, brain MRI, and lumbar puncture should be considered as clinically indicated."
In addition to RA, rituximab is approved for patients with relapsed or refractory, low-grade or follicular, CD20-positive, B-cell, non-Hodgkin's lymphoma (NHL) as a single agent, and for the treatment of previously untreated follicular CD20-positive, B-cell NHL in combination with CVP chemotherapy. Rituximab is indicated for the treatment of nonprogressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent, following first-line treatment with CVP chemotherapy.
Rituximab is also indicated for previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other anthracycline-based chemotherapy regimens.
And this.........
Actually, this really isn't new information, at least not to me. There were two PML associated deaths for people with Lupus who had used Rituxan. I was made aware of this by my RD and when you take into account the number of people who use Rituxan and the fact that this RA patient had oropharyngeal cancer, which was treated with chemotherapy (a platinum-containing regimen) and radiation therapy nine months prior to the development of PML, it doesn't seem like a huge risk to me.
Just my opinion though. People will have to decide whether or not this is an acceptable risk/ benefit ratio for themselves. For me, it's not even close. Rituxan has been a wondeful med for treating my RA and I will continue to use it......
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I I too, believe in biologicals and I trust my Rhem Dr..
haven't read a lot about it... but i'm for it!~
I'm on medicaid and care and the rest of meds are shown... :)
Also, bc of the strong meds, i am one, including Rituxan..
my Xrays show no major damage to my joints.. no sign of progression!!! Yay!!
Right now, I really really Need it!!!!!!!
and glad you're here :)
Welcome to the board :)
let us know what happens~I've had two sets of Rituxan infusions, the first in November 2007 and the second in June/July 2008. The first one didn't seem to help; however there were many complications right after the first infusions - several of my own medical problems including surgery for a ruptured Achilles tendon; my sister was suddenly diagnosed with cancer, and she died in early January; my own subsequent MRSA infection (from the tendon surgery) with hospitalizations and further surgery. So, I don't think the Rituxan had a chance, against all that stress.
The second set of infusions this summer DID help to reduce the inflammation in my hands, wrists, knees and neck, plus my level of fatigue was greatly reduced and I felt like doing things for the first time in many months. The down side for me is that the good effects seem to be wearing off already, three months later. You can have the infusions only once every six months or so.
I had mildly unpleasant side effects the first time - three days of mild nausea, severe headache, flu-like symptoms. After the first few days, I was fine. After the second set of infusions, I had only mild nausea for one day, and a headache for 2-3 days. None of these were bad enough to deter me from having future infusions.
In short, I give Rituxan a "good" recommendation; not great, but certainly worth doing. Fortunately, my insurance has covered the full cost both times. If I had to pay for it myself, I might reconsider having the infusions.
Thank you all for the information. My other concern is that I have to be off the enbrel for 3 weeks before I can start the rituxan. What if the rituxan fails? How long would I have to wait until I could go back on enbrel or humira? Good question for my rheumatologist.
Julie, I tried Rituxan in November of last year. I had no side effects whatsoever, and my ankle swelling seemed to go down just days after the infusion. However, that didn't last and unfortunately I never saw a real improvement from it. I was waiting to try something else (Orencia) and you basically have to wait for your B cells to come back first so that your immune system isn't too badly impaired. I had to wait until April. All the waiting is very frustrating, but is unfortunately part of this disease. What you should ask your rheumy though is whether you can go back on Enbrel at all, since it seems to me that docs don't like to put people back on the same medicines once they stop working or have problems. Also, my insurance covered the Rituxan, but my co-pay was still a couple hundred dollars. OTOH my Orencia infusions are a lot less and the mfr is covering my co-pay. Good luck with whatever you and your rheumy decide.Julie, also wanted to let you know that Rituxan isn't a new drug...it's been used to treat cancer for 10 years and was approved for RA 2.5 years ago.
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