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Rituximab Update

In September of 2012 I posted a blog about a biologic, Rituximab.  Some researchers had hoped this medication would prove to be an effective treatment for SLE.  Unfortunately, Rituximab  did not live up to expectations. However, the drug has been used to treat SLE  in rescue situations.  As such, it is tried when other options have failed. In many of these cases, Rituximab has been effective, especially when used along with  other drugs.
Even though clinical trials of Rituximab have not yielded promising results, investigation continues to see if it might be useful as part of a regimen with other lupus treatments.  As  experience with Rituximab accumulates–in doctors’ practices and in trials–data  is collected about potential side effects.  It is important for physicians and patients to be alert to these so that prompt action may be taken, if necessary.
A 2015 Hindawi Journal article reports a case of early-onset neutropenia and thrombocytopenia that was associated with the administration of Rituximab. The patient’s treating physicians entertained the possibility that these conditions may not have been caused by Rituximab but may have been a manifestation of SLE.  This analysis was rejected because the patient’s clinical profile did not support the conclusion.
This case of early-onset neutropenia and thrombocytopenia associated with Rituximab is unusual, if not unique. The authors of the Hindawi article contemplate the possibility that the side effects  may have also occurred in other cases but were not detected.
In any event, both  neutropenia and thrombocytopenia were transient in this case.  The  conditions cleared up 12 days after Rituximab therapy stopped.
risk of neutropenia is infection; a risk of thrombocytopenia is bleeding.
One thing that should be remembered as side effects of Rituximab are discussed: the medicine is used for very sick people, people who may not have many other options. Side effects will likely not be a reason to avoid treatment, but being aware of those side effects may help to keep the patient safe while treatment proceeds.
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