Rituxan (rituximab)

What it is: A biological therapy. In some conditions, B-cells produce harmful autoantibodies that attack the body's own tissues; rituximab depletes B-cells to reduce inflammation. Improvement comes within 2–16 weeks if you respond. It is prescribed for rheumatoid arthritis, lupus, vasculitis, and dermatomyositis.

Before starting: It is not started if your arthritis isn't active, other appropriate treatments have not been tried first, or you have an infection. It may not be prescribed if you are pregnant or breastfeeding, have severe heart problems, get easily short of breath, have low B-cell or antibody levels, or have seronegative RA. Blood tests (antibody and possibly B-cell levels) are done before starting and every few months after, plus a hepatitis check.

How it's taken: By intravenous infusion in our infusion suite — the first infusion takes about 6 hours, and later ones are shorter. Usually two infusions are given two weeks apart, repeated when the benefit wears off (around 6 months to 3 years later; many people need it about once a year). A steroid injection or infusion plus paracetamol and an antihistamine are often given first to reduce reaction risk.

Side effects: Some people experience fever, wheeziness, rash, or a blood-pressure drop during or shortly after the infusion — tell the infusion nurse, who can slow the drip; severe reactions are rare. Infection risk is increased — report a sore throat, fever, or new concerning symptoms. Chickenpox and shingles can be more severe. After 3–4 courses, protective antibody levels may fall, rarely increasing infection risk with repeated courses. Very rarely: severe skin reactions up to four months after an infusion, and progressive multifocal leukoencephalopathy (PML — brain and spinal cord damage): see a doctor immediately for pins and needles, weakness, unsteadiness, vision loss, speech problems, behaviour or mood changes, or movement difficulty.

Surgery: Planned operations are usually scheduled at least a month after your last infusion — make sure your surgeon knows you are on rituximab.

Pregnancy: The effect on the unborn baby is unknown; avoid pregnancy for at least six months after treatment. Treatment in early pregnancy (before it is confirmed) is unlikely to be harmful. Guidelines say men trying to father a child can take rituximab. The antibody can pass into breast milk (effects unknown) — don't have rituximab treatments while breastfeeding.

Why the checks: Screening is specific here: hepatitis B testing matters because B-cell depletion can reactivate the virus months later; antibody (immunoglobulin) levels are followed because repeated courses can lower them, which changes infection risk; and vaccination review happens before treatment because vaccines given while B cells are absent barely work — timing them first gets you their protection.

Used for Rheumatoid arthritis · Vasculitis · Lupus (SLE) · Dermatomyositis