Rituximab

How it works

It binds the CD20 antigen on B lymphocytes and triggers their depletion through complement-dependent and antibody-dependent cytotoxicity and apoptosis, reducing pathogenic antibody production and inflammation.

Prescribing in practice

• Hepatitis B reactivation can be fatal, so screen for hepatitis B (and consider other viral screening) before treatment and monitor or provide prophylaxis as advised.
• Infusion-related reactions are common, particularly with the first infusion, and premedication is used to reduce their severity.
• It increases infection risk and rare progressive multifocal leukoencephalopathy has been reported.

Monitoring

Monitor full blood count, immunoglobulins and for signs of infection, with viral screening before treatment.

Counselling the patient

• Report any signs of infection or new neurological symptoms such as confusion or weakness promptly.
• Tell the team about reactions during or after the infusion such as rash, breathlessness or fever.
• Ensure recommended vaccinations are up to date before treatment and avoid live vaccines.

Evidence & guidelines

Use in rheumatology is supported by NICE guidance and pivotal trials including RAVE in ANCA-associated vasculitis.