Hugh Duckworth MD
Hugh Duckworth MD

Doctor of Medicine (M.D.) in 1984 from University of Tennessee School of Medicine

Sep 28, 2018 4 min read

Rituxan: How Effective is Rituxan for Treating Rheumatoid Arthritis?

An autoimmune disorder where the body’s immune system essentially attacks its own joints, Rheumatoid Arthritis is a painful condition afflicting more than 1.3 million Americans. And, in most cases, women are the victims of this debilitating disease – over 75% of the cases of RA are found in women.

In mild to moderate cases of Rheumatoid Arthritis, individuals can have significant joint pain due to the inflammation. In more moderate to severe cases of RA, individuals can experience bone erosion, joint deformity, loss of mobility, and damage to nearby and systemic organs.

Treatment to alleviate the symptoms of Rheumatoid Arthritis includes drug therapy, physical therapy, and homeopathic medicines. In more advanced stages of Rheumatoid Arthritis, a drug called Rituxan has been approved for treatment, usually in combination with a TNF (tumor necrosis factor) antagonist that is not effective on its own.

 

What is Rituxan?

Rituxan (Rituximab) is a monoclonal antibody that works to inhibit CD20, a protein found on the surface of a type of white blood cell called mature B-cells. CD20 and B-cells are responsible for promoting inflammation in response to tissue or cell damage perceived by our bodies. With RA, our bodies are basically attacking themselves, creating joint inflammation when no injury is present. As such, Rituxan is prescribed in to order to interfere with the inflammatory process,  preventing the body from releasing signals that stimulate joint inflammation. Thus, minimizing the occurrence of pain and joint damage associated with this RF induced inflammation.

There have been a number of clinical trials conducted to study the effects of Rituxan on RA symptoms. In all of the controlled studies, Rituxan was found to have a beneficial effect on the treatment of RA symptoms over just methotrexate alone, placebos, and methotrexate + placebos. One of the most recent clinical studies of Rituxan shows that there is little to no significant difference between users who take Rituxan at high doses versus those that take it in low doses to treat RA.   When steroids were added to  Rituxan therapy, it was shown that the combination did not represent a significant benefit over Rituxan alone, regardless of the size of the dose. This is good news for the Rheumatoid Arthritis community.  Steroids have long been used in the treatment of RA.  Despite their effectiveness at diminishing inflammation, they have many negative and sometimes serious side effects. These results suggest that steroids are may not always be needed in combination with all RA drugs, and lower doses of Rituxan are virtually just as effective as higher doses of the drug.  The addition of steroids are effective in helping to alleviate some of the post-infusion side effects of Rituxan.

 

How to Take It

Rituxan is given intravenously. As it is usually given in combination with the DMARD methotrexate, two separate infusions are given into the vein of 1000mg at two-week intervals. Beyond the initial treatment, Rituxan is given at 24-week intervals.

Rituxan infusions usually last anywhere between 4-6 hours. Courses of Rituxan should not be given at intervals less than 16 weeks.

 

Side Effects

Some side effects from taking Rituxan can be severe, even deadly. It’s important to fully inform  the prescribing physician of your detailed medical history and consult with your doctor if you experience any of the following after taking Rituxan:

  • Stomach upset/problems/pain
  • Bowel upset/pain
  • Chest pain
  • Irregular heartbeat
  • Urinary or Kidney problems
  • Resultant infections
  • Skin and mouth reactions
  • Hepatitis B virus reactivation
  • Low blood cells counts

Because some of these side effects can be life-threatening, it’s important to contact your physician right away if you suspect you are experiencing any negative effects from the use of Rituxan.

Some less severe/more common side effects of Rituxan typically occur right after the infusion is complete. These more mild symptoms include:

  • Fever
  • Chills
  • Body aches
  • Infusion reactions
  • Tiredness
  • Aching joints
  • More frequent respiratory tract infections

 

Warnings and Precautions

Because Rituxan can interact with other types of medications and/or worsen symptoms of existing diseases, it’s important to let your doctor know if you experience any of the following:

  • Heart problems
  • Lung or kidney problems
  • Previous reaction to Rituxan
  • Currently, have an infection or a weakened immune system
  • Have recently had or will be having a vaccine
  • Are pregnant or trying to get pregnant
  • Are breastfeeding or plan on breastfeeding
  • Are taking any medications, especially TNF inhibitor medications or DMARDs