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Rushmere Day Unit
Ipswich Hospital
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Treating kidney disease with rituximab

Rituximab is a drug that can help prevent your immune system causing damage to your body. This leaflet explains about rituximab treatment for kidney diseases, including the benefits, risks and what you can expect during your treatment. You still need to discuss with your kidney doctor before you make an informed decision.

What is rituximab and how does it work?

Rituximab is a type of drug known as a biological therapy. It is also known by the names MabThera, Rixathon and Truxima.

The immune system normally works by protecting the body from infections by causing inflammation. In some illnesses, the immune system becomes too active and fights the person’s own body instead of helping to protect it. These kinds of diseases are called autoimmune diseases like vasculitis and Systemic Lupus Erythematosus (SLE). ‘B cells’ are a type of white blood cells found in your blood and are involved in making proteins (antibodies) which are causing your illness. Rituximab works by removing these B cells from the blood for several months. After this, levels of B cells will slowly return to normal.

How long does rituximab take to work?

Rituximab usually takes about four to six weeks to work, and the effect of rituximab usually lasts up to nine months. The first two doses are given two to three weeks apart, and then if rituximab works for you, you may be given further doses. In most cases only one course is needed, but you can have repeat courses after 6 to 12 months if the doctor thinks you need this. If you have complications from the treatment, or the treatment does not work, your doctor will discuss other treatment options with you.

How is rituximab given?

• You will be given a time slot to arrive at Rushmere Medical Day Unit.
• You can have your usual breakfast in the morning;. Please bring all of your medications with you.
• Rituximab is given as an infusion into a vein in your arm by a trained nurse

You will be prescribed other medications before the infusion to reduce side effects that can be caused by the infusion. These medications are oral paracetamol and two drips through the cannula of chlorphenamine (an antihistamine also called piriton) and methylprednisolone (steroid).

The first infusion takes around five to seven hours in total. If you tolerate this well, further treatments can be administered faster.

If you have any symptoms of an infection when you come for the infusion, you must tell the nurse or doctor straight away. It is not safe to give you rituximab when you have an infection.

What side effects might I experience?

Most people tolerate rituximab very well with few side effects. If they occur, side effects can begin during the first dose and may continue for a few hours afterwards but are usually milder with further doses.

During the infusion

A few people experience a fever, wheeziness, a rash or fall in blood pressure during or shortly after the infusion, or you may feel unwell during infusions. If this happens, tell the nurse and he or she will adjust the infusion rate and/or give you medications to help. The symptoms are usually milder with further doses. If your symptoms are severe you may need to stop treatment, but this is rare.

Other adverse effects

Rituximab may, in rare cases, cause temporary abnormalities of your blood counts and affect liver functions. This can manifest as being more prone to infection, easy bruising, bleeding, or tiredness.

Exceedingly rare side effects

Some patients (fewer than 1 in 100,000) taking rituximab have had a serious brain condition called progressive multifocal leucoencephalopathy (PML), which damages the brain and nervous system and can be fatal. Symptoms can include weakness, difficulty with movements (face, arms or legs), shaky movements or unsteadiness, pins and needles, sight loss, speech problems and/or changes in behaviour or mood.

If you experience any of these symptoms, you must tell your doctor straight away.

Taking medicines with rituximab

You should discuss any new medications with your doctor before starting them, and you should also tell any other doctor treating you that you are taking rituximab. Do not take ‘over-the-counter’ preparations without first discussing it with your doctor, nurse, or pharmacist.

Fertility, pregnancy, and breastfeeding

Avoid starting a family and breastfeeding during and for 12 months after treatment with rituximab. The risk is unknown. Women of child-bearing age must use contraception while on rituximab.

Having an operation

If you need to have an operation, this will usually be scheduled for at least three months after your last infusion. Make sure your surgeon knows you’re on rituximab.

Immunisations

• Live vaccines (such as typhoid, polio, rubella, BCG, chicken pox, shingles) should be avoided.
• Non live vaccine (such as flu and pneumococcal) can be given but discuss with your doctor first.
• The coronavirus (COVID-19) vaccine, where clinically possible, should be given four weeks or more before rituximab. There may be a reduced response to coronavirus (COVID-19) vaccines, especially for people within six months of the last dose of rituximab.

Chickenpox and shingles

You should see your doctor if you develop chickenpox or shingles or come into contact with someone who has chickenpox or shingles. It is important to try to avoid any unnecessary contact with people known to have an infection.

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