Talk:Rituximab

Use of rituximab

While it is true that the FDA-approved use of rituximab is for relapsed or refractory lymphoma, its off label use in combination with CHOP is standard clinical practice in the U.S. for treating e.g. diffuse large B cell lymphoma upfront. Andrew73 20:28, 22 October 2005 (UTC)

The same is true in the UK. JFW | T@lk 22:14, 22 October 2005 (UTC)

At this point, rituximab is fully licensed for use with ANCA vasculitis in the US (i.e., MPO, GPA, etc) - this is not an off label use.

Its use in SLE and dermatomyositis is...complex. With regards to lupus nephritis (and to some extent SLE at large), the data are very mixed (see the LUNAR and EXPLORER trials, among others). It tends to be much more effective for non-renal manifestations of SLE, and I have patients for which it has been extremely effective in this regard. There is much less data for its use in dermatomyositis - evidence for effect tends to be anecdotal at best. (I'm a rheumatologist.)

SLE

I could not find one nice representative study to illustrate the SLE thing. PMID 15550531 is a hodgepodge of diseases and not really useful. JFW | T@lk 22:30, 3 January 2006 (UTC)

Epitope on CD20

PMID 16705086 - they've been looking for the bit of CD20 that rituximab binds to. JFW | T@lk 21:12, 6 September 2006 (UTC)

NHS approval

I'm not knowledgeable enough to be sure where (or if) this news should be mentioned, but it's currently the top story on the BBC News website's Health section. Loganberry (Talk) 00:35, 22 August 2007 (UTC)

NICE TA137 is the NICE technology appraisal for rituximab in follicular lymphoma. JFW | T@lk 08:52, 29 February 2008 (UTC)

Mechanism of action

Internalization/degradation of the CD20 receptor has been observed and provides a basic means of resistance to the drug (will provide PMID citation). Thebingaman (talk) 05:06, 16 July 2008 (UTC)

Resistance

I think a section describing the acquisition of Rituximab resistance or remission/relapse would be useful, and would elucidate the mechanism section that already needs to be expanded. What does everyone think? Thebingaman (talk) 05:09, 16 July 2008 (UTC)

I think it would be difficult to produce a section that is complete, accurate, and properly sourced, but I'm perfectly willing to let you try. We could surely do better than we have so far. WhatamIdoing (talk) 05:13, 17 July 2008 (UTC)

Rituximab vs humanized

The value of a humanized molecule in oncology has not been demonstrated to this date.

Um, don't we mean something like the unique value of a humanized mAb hasn't been demonstrated for oncology? Surely no one thinks that a fully humanized Fc (and other bits) that uses the same Fab for binding will actually be ineffective? And shouldn't it eliminate the concerns about murine-related allergies? WhatamIdoing (talk) 06:45, 23 August 2008 (UTC)

POV

I have some concerns about this edit, which has the overall effect of significantly minimizing the serious (deadly) adverse effects associated with this medication. But -- perhaps it's okay. Perhaps this is simply the effect of contextualizing the risks. What do other people think? And Lady Cairns, can you give me an idea of what your goal is, and whether or not you actually checked the listed sources to make sure that they explicitly make these statements? WhatamIdoing (talk) 06:50, 3 December 2008 (UTC)

I strongly agree with you. Lady Cairns seems intent on minimising a) the seriousness of PML and b) the significance of the relationship between this drug and PML. I will go ahead and remove her unreferenced speculation regarding the alleged role of lupus in causing PML in these patients. —Preceding unsigned comment added by 149.171.232.72 (talk) 02:29, 15 November 2009 (UTC)

Dermatomyositis

the dermatomyositis article lists rituximab as a rx, with a reference. i hesitate to add it myself only because i'd screw up adding said reference. Toyokuni3 (talk)

I don't think I'd bother. It's only at the "promising" level of evidence. If it were widely accepted, or if (like SLE) there were a couple of high-profile deaths as a result, it might be worthwhile, but I'm not sure that including it would be WP:DUE. (I'm open to other opinions.) WhatamIdoing (talk) 20:51, 8 October 2009 (UTC)

It is now 2012 and obviously things have happened since 2009. Rituximab is being now fairly widely used in recalcitrant cases of dermatomyositis, sometimes even before IVIG or cyclophosphamide is tried.

However the big double blind study "Rituximab in Myopathy" was poorly designed and so has not been published in a peer reviewed journal (yet).

I'm a dermatomyositis patient, not a medical person, so I too hesitate to make the change. But would a medical person mind considering it?

To save you some time here is a reference:

http://www.mayoclinic.com/health/dermatomyositis/DS00335/DSECTION=treatments-and-drugs 50.71.37.239 (talk) 14:19, 18 February 2012 (UTC)

As well as the Mayo Clinic, PubMed and google have dozens of papers and letters to journal editors documenting the use of rituximab for dermatomyositis, so as much documentation of as high a quality on its actual use as for any other use -- but no double blind study.

The RIM Study was CLINICAL PHASE II (200 DM and PM patients). Phase II, so that means safety is not proven when the study began? The poor design of the study meant it could not show effectiveness and that is why it has not been published (yet).

So I went back to just make the change myself, to add it to the safety not proven list. But Wikipedia has got to get a proper WYSIWYG type editor because all this markup language stuff on the weekend -- I don't want to mess up what is already there by mistake.

50.71.37.239 (talk) 14:36, 18 February 2012 (UTC)

Suggest split out most of section : Other anti-CD20 monoclonals

Since this section could be repeated in any of the current and forthcoming anti-CD20 mab articles are there any objections to moving it to CD20 or a new anti-CD20 ? Rod57 (talk) 00:40, 14 December 2009 (UTC)

Hi Rod57, I agree that the other section should be (re)moved. What caught my eye, however, was the (now deleted) Innexus reference which appears to be not-so-disguised promotion. The molecule in question is an autophilic mAb based on rituxan (prepared by Heinz Kohler). It has not emerged from preclinical work. TyroneMiller (talk) 15:32, 30 December 2009 (UTC)

Similar is now in CD20#Clinical_significance so could sync it and trim this section. - Rod57 (talk) 02:22, 20 March 2016 (UTC)

Should table in wikipedia on biologics include rituximab?

The table is here. I'm a dermatomyositis patient, not a medical or pharmaceutical professional, so I hesitate to make the change myself. http://en.wikipedia.org/wiki/Biologic

If not, then okay to just delete this suggestion. — Preceding unsigned comment added by 50.71.37.239 (talk) 14:21, 18 February 2012 (UTC)

Why undo, Graves vs thyroid

I changed "thyroid-associated ophthalmopathy" to "Graves' disease ophthalmopathy" and then a later editor changed it back citing the wording in the abstract ref.

Here is my reasoning for my change:

The abstract ref wording is sloppy. Graves attacks the thyroid, tissue in the area of the eyes, and skin. The use of thyroid-associated carries the false implication of causality between the thyroid and eye problem.

If you look at the definition of thyroid-associated ophthalmopathy at, for example, http://emedicine.medscape.com/article/1218444-overview you will see "Thyroid-associated orbitopathy (TAO), frequently termed Graves ophthalmopathy, is part of an autoimmune process that can affect the orbital and periorbital tissue, the thyroid gland, and, rarely, the pretibial skin or digits (thyroid acropachy). Although the use of the term thyroid ophthalmopathy is pervasive, the disease process is actually an orbitopathy in which the orbital and periocular soft tissues are primarily affected with secondary effects on the eye."

So this sloppy and misleading term exists, but the medical community recognizes that it is sloppy and misleading, and we should not propagate it and mislead readers when a better term is in use. Trudyjh (talk) 08:25, 7 April 2012 (UTC)

That seems fair enough. I just wanted to make sure this wasn't some kind of advocacy for Graves disease or something...some medical articles see a lot of edits like that, so I tend to be wary of changes that could potentially imply a single cause when there might be others. I'll ask one of the doctors I know on the site to take a quick peek at it and see if he concurs, as I'm not qualified to make any kind of judgment here. – RobinHood70 ^talk 20:07, 7 April 2012 (UTC)

All thyroid diseases are associated with eye signs (e.g. lid lag), but Graves uniquely involves the retroorbital musculature and can cause significant eye pathology that can progress to blindness. I agree that "Graves' ophthalmopathy" is a reasonable choice of words. JFW | T@lk 20:37, 8 April 2012 (UTC)

Thanks, Jfdwolff! – RobinHood70 ^talk 21:05, 8 April 2012 (UTC)

How is rituximab ADMINISTERED?

How is rituximab ADMINISTERED? "???" Someone who knows the answer to this, please add it to the article (e.g., in the introductory paragraph, perhaps as well as in a new section ("Drug administration"?)... Is it IV, a pill, or what? (If this info is in the article, I must've missed it.) Thanks.... philiptdotcom (talk) 21:25, 8 December 2012 (UTC)

The answer is provided at http://www.drugs.com/rituxan.html (but I'm not sure this is the best source; will leave the actual change to someone who really knows the online literature/can provide the best source/etc.). Aloha... philiptdotcom (talk) 21:29, 8 December 2012 (UTC)

The information is in the box at the top right of the page. It says "Routes: intravenous infusion only (never bolus or "push")". There are several styles of equipment for intravenous infusions, but all of them involve putting a plastic line into a vein, and (slowly) pouring the drug through that. WhatamIdoing (talk) 03:06, 9 December 2012 (UTC)

i get rituximab since 3 years now against my multiples sclerosis. i get 2 infusions every 6 months only 14 days apart with 500mg rituximab. as User WhatamIdoing already said i get it as an infusion very slowly together with 500ml of NaCl and it takes about 4 hours. If you get it to fast you will have adverse effects. Sometimes i get bored during the infusion so i make it a bit faster :p when i do that my ears are getting red and my throat swells and itches. — Preceding unsigned comment added by 87.179.216.156 (talk) 00:06, 30 January 2014 (UTC)

Now the patent is expired, are biosimilars available or in development

Now the patent is expired (in 2015), are biosimilars available or in development ? - Rod57 (talk) 02:13, 20 March 2016 (UTC)

I've added some info on two recent biosimilars going through the approval process in Europe Afcone (talk) 17:55, 29 April 2017 (UTC)

That may have been removed (without discussion?) - I think we should have a section on biosimilars and list all the ones approved anywhere in the world - any objections ? Existing ref [1] has a nice list. - Rod57 (talk) 22:38, 16 September 2018 (UTC)

Is it used off-label for MS

Is it used off-label for MS, given how well it was doing in clinical trials before they were stopped in favour of Ocrelizumab ? - Rod57 (talk) 02:13, 20 March 2016 (UTC)

Apparently yes - says Ocrelizumab - Rod57 (talk) 22:35, 16 September 2018 (UTC)

Rod57 Yes still. Sweden is currently doing a cohort study on efficacy with Kaiser, CombatMS, extend release date again.. but the rituximab is no better no worse with supporters/detractors in both patients and doctors. Jennablurrs7575 (talk) 12:38, 16 June 2019 (UTC)

price

uned2calculatethat/YEAR62.235.177.130 (talk) 15:21, 24 December 2016 (UTC)

CFS trials - dates conflict

"A new multi-centre double-blinded trial with 152 patients began in October 2014,[25] after a follow-up open study published in July 2015 suggested a longer acting effect...." Confusing because Oct 2014 is not after July 2015. Was the double-blinded trial based on pre-publication information from the follow-up study? Have put the second date in brackets. Perhaps the connection between the studies can be further clarified? 94.2.47.249 (talk) 21:01, 27 March 2017 (UTC)

Link to ref 29 is broken. References 27 and 28 appear to predate the studies they are referring to?

Problematic edit, content. Biosimilar and Generic are far (how far?) from equivalent?

1. I was looking for info on Rixathon and found https://en.wikipedia.org/w/index.php?diff=prev&oldid=830818238 removed the names of numerous rituximab biosimilars that redirect here - Blitzima, Tuxella, Ritemvia, Rixathon and Truxima. Some of these are redirects to this page; removal is thus inappropriate. However I do note that the biosimilar Rixathon was "Rejected by FDA in May 2018." I wonder why! Others include Riabni, Ruxience, and Truxima... Adding...

2. Also, "A biosimilar is not regarded as a generic of a biological medicine" is well known in the field, yet we incorrectly describe all the biosimilars as "a medication". I'll be fixing this but want to highlight the problem before doing so.

3. It strikes me as nonsensical that a drug can be patented if the patent doesn't describe a way to manufacture the drug. I (vaguely) recall that a valid patent must provide a complete description of how to replicate the innovation. (To be continued...)

--50.201.195.170 (talk) 20:33, 29 June 2021 (UTC)

Increased death risk for Covid patients

• Larkin M. Rituximab Likely Raises Risk of Hospital Death in COVID-19 Patients. Reuters Health Information. December 03, 2021. Republished online in Medscape. Tuesday, December 7, 2021

"In hospitalized COVID-19 patients on immunosuppressive therapy, only those taking rituximab had an increased risk of in-hospital death in a retrospective analysis."

Paging Whywhenwhohow

@Whywhenwhohow, discuss and respond here or there to https://en.wikipedia.org/wiki/User_talk:Whywhenwhohow#Your_repeated_pushing_of_your_preferred_version_without_discussion_and_based_on_falsity. Thanks. RememberOrwell (talk) 06:33, 8 July 2024 (UTC)

Looks like some brilliant editing from Whywhenwhohow. RememberOrwell, please review the following policy pages to refresh any misguided beliefs WP:NOTPRICE, WP:BRD, WP:ONUS. Pabsoluterince (talk) 01:16, 9 July 2024 (UTC)

First of all, aren't they the ones violating WP:BRD / WP:EDITING? They violated "If your edit gets reverted, do not revert again. Instead, begin a discussion with the person who reverted your change." You dispute that? Whywhenwhohow did the opposite of both of those instructions, no? So what belief(s) of mine are you implying is(are) misguided, specifically? RememberOrwell (talk) 04:29, 10 July 2024 (UTC)

Bump. RememberOrwell (talk) 06:36, 22 August 2024 (UTC)

Pricing

Moving on, Pabsoluterince, I see WP:NOTPRICE doesn't say no prices. I read "include product pricing or availability information [if] there is an independent source and encyclopedic significance for the mention [as here, where] indicated by mainstream media sources". RememberOrwell (talk) 04:30, 10 July 2024 (UTC)

I read the same! Pabsoluterince (talk) 03:48, 11 July 2024 (UTC)

RememberOrwell I read the direct quote similarly to you but see no evidence of mainstream media sources reporting on the price of Rituximab. Pabsoluterince (talk) 10:00, 21 August 2024 (UTC)

Look again. You deleted multiple (3?) media sources reporting on the price of Rituximab from the article. There are plenty more out there. There are even several articles in the literature on the price of rituximab. RememberOrwell (talk) 05:34, 22 August 2024 (UTC)

The specific source of contention was the mainstream nature of the media source, which in my mind doesn't include journal publication by its restricted definition. But it's a brief mention, with relevance to pricing of recent biosimilars so I think it does have encyclopaedic relevance. I trust you will let me know if I have improved the overall fluidity. Pabsoluterince (talk) 12:14, 22 August 2024 (UTC)

Shorter and more fluid now. :-) RememberOrwell (talk) 08:34, 26 August 2024 (UTC)

Dr Reddy's version of Rituximab retails for around ₹ 10,000 / 500 ml vial. ($100) in India. https://dir.indiamart.com/impcat/reditux-injection.html. N/A in the US, Can't find EU pricing. Secret. RememberOrwell (talk) 02:03, 1 October 2024 (UTC)

References

ME misinformation

Re: "This potential use was investigated after improvements in ME/CFS was seen in two cancer patients treated with rituximab." I sought to fix the grammar error in this sentence and fell into a rabbit hole. To determine whether [improvements in ME/CFS were] or [improvement in ME/CFS was] fit, I checked the source, and it doesn't fit the sentence at all. The section on Rituximab indicates : There was 1 cancer patient, but then 3/3 patients in a pilot trial did well when dosed and after challenge, then a positive larger trial, then a positive 30-person RCT, and then the Invest in ME and RituxME trials were launched. One of these latter two trials is presumably the negative trial referred to in the sentence before the one quoted above that I sought to fix. These two any any further trials and reviews need checking.

Weird. The editor who inserted it hasn't been active for years.

Any thoughts? RememberOrwell (talk) 07:10, 22 August 2024 (UTC)

I read the same as you, but there is another thing. The initial publication's Case history describes the first patient's chemotherapy with the chemotherapy regimen of ABVD, followed by MIME. It was during the first and second dose of the MIME regimen that "the patient unexpectedly started a remarkable recovery from all CFS symptoms [...] for 4–5 months". The ABVD and MINE regimens do not contain rituximab. It was only after that, that the initial patient and two additional patients took part in the rituximab trial. I think the whole discovery line should be removed because it is the methotrexate induced B-cell depletion that is the suggestive cause of that initial 4–5 month remittance. Pabsoluterince (talk) 13:16, 22 August 2024 (UTC)

Also I don't know who you were referring to but the editor who added the information was blocked in 2018. Pabsoluterince (talk) 13:40, 22 August 2024 (UTC)

Nice leap in the right direction. Were the Invest in ME and RituxME trials both negative? How big were they? Which was "Phase III"? (In other words, I can't tell - have you checked what I said "need checking"?) RememberOrwell (talk) 08:43, 26 August 2024 (UTC)

This is the most recent review article I found on the topic. In 3.2.1. Immunosuppressive Treatments it describes a series of promising trials, followed by the 151 person trial which didn't find any improvements. Pabsoluterince (talk) 04:52, 27 August 2024 (UTC)