PT - JOURNAL ARTICLE AU - Daniel H Whittam AU - Emma C Tallantyre AU - Stephen Jolles AU - Saif Huda AU - Robert J Moots AU - Ho Jin Kim AU - Neil P Robertson AU - Bruce A C Cree AU - Anu Jacob TI - Rituximab in neurological disease: principles, evidence and practice AID - 10.1136/practneurol-2018-001899 DP - 2019 Feb 01 TA - Practical Neurology PG - 5--20 VI - 19 IP - 1 4099 - http://pn.bmj.com/content/19/1/5.short 4100 - http://pn.bmj.com/content/19/1/5.full SO - Pract Neurol2019 Feb 01; 19 AB - Rituximab is a widely used B-cell-depleting monoclonal antibody. It is unlicensed for use in neurological disorders and there are no treatment guidelines. However, as a rapidly acting, targeted therapy with growing evidence of efficacy and tolerability in several neuroinflammatory disorders, it is an attractive alternative to conventional immunomodulatory medications. This practical review aims to explain the basic principles of B-cell depletion with therapeutic monoclonal antibodies. We present the evidence for using rituximab in neurological diseases, and describe the practical aspects of prescribing, including dosing, monitoring, safety, treatment failure and its use in special circumstances such as coexisting viral hepatitis, pregnancy and lactation. We provide an administration guide, checklist and patient information leaflet, which can be adapted for local use. Finally, we review the safety data of rituximab and ocrelizumab (a newer and recently licensed B-cell-depleting therapy for multiple sclerosis) and suggest monitoring and risk reduction strategies.