1. How does it work?
Rituximab works by killing B-cells, a type of white blood cell felt to cause inflammation leading to injury in NMOSD. Mechanistically this drug is similar to Inebilizumab.
2. Who should not take this drug?
Talk with your doctor about any potential contraindications to Rituximab.
3. How is it taken?
Intravascular (IV) infusion in an outpatient infusion center.
4. How often is it generally taken?
One infusion every six months, with the exception of the first dose which is divided into two infusions (at week 0 and week 2).
5. What is the typical dosage?
1000 mg every six months.
6. How much does it reduce my risk of relapse?
As a clinical trial has not been performed yet on these medications for NMOSD, the estimated relapse risk decrease has not been calculated. Like many other neurologic autoimmune conditions, physicians used this medication before there were FDA approved therapies available as a general immunosuppressant. It is still considered a standard of care and potential option for treatment of NMOSD by most doctors.
7. What are the side effects?
There is a higher risk of infections, most commonly respiratory tract and urinary tract infections. There can be reactivation of old infections, like hepatitis and tuberculosis, which your doctor will screen for before starting the medication. Infusion reactions may occur, ranging from flu-like symptoms, low blood pressure, hives to swelling, shortness of breath and, in more severe cases, shock.
8. What should I do to prepare for taking this?
Your doctor should check your blood work for cell counts, liver enzymes, tuberculosis, and hepatitis.
9. What ongoing monitoring should occur when taking this drug?
Yearly tuberculosis and hepatitis screening. Your doctor may monitor your blood counts, including B-cell count, to determine if the drug is still working in your body.
10. Who makes this medication?
Rituxan is produced by Genentech (a member of Roche). MabThera is produced by Roche. Truxema, a biosimilar of Rituximab, is produced by Teva.
11. How can I get help paying for it?
You can work with your doctor or local hospital’s social work department to try to get assistance covering these medications.
12. Can I take it if I’m pregnant?
Rituximab is a pregnancy category C medication. This may be a medication that can be taken before conception if planned but should be discussed on an individual basis with your physician. Babies of pregnant people taking Rituximab can have low B-cell counts, which may require monitoring.
13. Clinical trial information
Studies investigating Rituximab have largely been retrospective and not placebo-controlled trials, but have indicated reductions in relapse rates for those with NMOSD.
14. Will my insurance cover it?
This will depend on your insurance company and the billing code your doctor uses. For specific questions, call the customer service phone number on the back of your insurance card with the name of the drug in question, as well as ICD (diagnostic) code your doctor uses.
15. Is it FDA approved for NMOSD?
No, it is used off-label.