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Updated May 2021
Rituximab (brand name Mabthera) belongs to a new class of medicines called biological disease modifying antirheumatic drugs (biological DMARDs or bDMARDs).
bDMARDs have now been given to over a million people worldwide since their initial use in the late 1990s.
B-cells are white blood cells, which normally produce ‘antibodies’. Antibodies help protect the body from infections. In rheumatoid arthritis however, some B-cells produce harmful ‘autoantibodies’, which cause inflammation in the joints. These result in pain, joint swelling and stiffness, and can lead to joint damage.
By temporarily removing the harmful B-cells, rituximab reduces inflammation, lessens the symptoms and helps stop further joint damage. Rituximab also removes some ‘good’ B-cells, but these return some months after treatment.
Because of its effects on harmful B-cells, rituximab has been used for many years to treat lymphoma, a cancer of the B-cells in lymph nodes.
The improvement in your arthritis from rituximab may take a number of weeks. Benefits will usually be seen by 3 months.
Continue with your treatment unless advised by your doctor or unless side effects develop (see Side effects).
If you stop rituximab for any reason you must contact your doctor. Failure to do so may mean that your continued treatment may no longer be subsidised.
In view of the current prescribing restrictions for all bDMARDs:
Rituximab is given as a drip (infusion) into the vein. The infusion normally takes 2 to 4 hours. You will need to stay for at least an hour after the infusion to make sure you don’t have any side effects.
Rituximab is given in combination with the DMARD methotrexate.
Sometimes a boost of a steroid may be used as part of a premedication to reduce side effects (see Side effects).
A course of treatment usually consists of 2 doses given two weeks apart. The dosage is 1000mg for each of the infusions. Sometimes it is given weekly for 4 weeks.
Rituximab may be used with other arthritis medicines including:
There are separate information sheets for the medicines mentioned above.
Rituximab cannot be used with other bDMARDs. It should also not be given within 2 weeks of tofacitinib, 4 weeks of treatment with etanercept (Enbrel, Brenzys), within 8 weeks of receiving infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab (Cimzia), tolicilizumab (Actemra) or abatacept (Orencia).
A course of treatment is usually repeated every six months for Rheumatoid Arthritis. Your response will be monitored by your rheumatologist, with blood tests and examination, about 3 to 4 months after your last infusion.
You might experience side effects with your treatment. Contact your doctor if you have any concerns about possible side effects. Many side effects disappear when rituximab treatment is stopped.
These effects can usually be reduced by giving corticosteroids (e.g. prednisone or cortisone), antihistamines and paracetamol before the treatment.