Related Subjects:
|Progressive Multifocal Leukoencephalopathy (PML)
|Rheumatoid arthritis
💉 Rituximab is a chimeric monoclonal antibody targeting CD20 on B lymphocytes.
⚠️ Rare but serious risks include progressive multifocal leukoencephalopathy (PML), reported in patients with autoimmune disease (e.g., SLE).
Resuscitation equipment must always be available during administration.
📖 About
- Targets CD20+ B cells → depletion of circulating and tissue B lymphocytes.
- Used in both haematological malignancies and autoimmune diseases.
- Check BNF here for current prescribing guidance.
⚙️ Mechanism of Action
- Monoclonal antibody binding to CD20 antigen on B cells.
- Causes complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity → B cell apoptosis and depletion.
- Reduces autoantibody production in autoimmune disease.
🎯 Indications
- Haematology: recurrent or refractory follicular lymphoma, aggressive B cell NHL, diffuse large B cell lymphoma.
- Rheumatology/Immunology: Rheumatoid arthritis, SLE, Sjögren’s syndrome, antiphospholipid syndrome, dermatomyositis, ITP.
- Neurology: CIDP (chronic inflammatory demyelinating polyneuropathy), some cases with paraproteinaemia.
⛔ Contraindications
- Active or severe uncontrolled infections.
- Severe immunosuppression.
⚠️ Side Effects
- Infusion reactions (cytokine release: fever, rigors, dyspnoea, hypotension). Premedicate with steroids + antihistamines.
- Cardiac complications: can exacerbate angina or ischaemia.
- Type III hypersensitivity reactions (immune complex–mediated).
- Bone marrow suppression → pancytopenia, infection risk.
- PML (progressive multifocal leukoencephalopathy): rare, often fatal JC virus reactivation.
- Other: tumour lysis syndrome, ARDS, transient hypotension, nausea/vomiting.
💊 Dose & Administration (check BNF/local policy)
- IV infusion, dose varies by indication (e.g., 375 mg/m² weekly x 4 for lymphoma; 1 g IV on days 1 & 15 for RA).
- Administer slowly, with gradual rate escalation.
- Withhold antihypertensives 12 h before infusion to avoid severe hypotension.
- Resuscitation equipment must be immediately available.
💡 Clinical Pearls
- Monitor CBC regularly → risk of cytopenias.
- Screen for hepatitis B before treatment → risk of reactivation.
- Always premedicate with steroid + antihistamine to reduce infusion reactions.
- Warn patients about the very rare but fatal risk of PML; new neurological symptoms warrant urgent evaluation.
📚 References
