RT Journal Article
SR Electronic
T1 Rituximab in neurological disease: principles, evidence and practice
JF Practical Neurology
JO Pract Neurol
FD BMJ Publishing Group Ltd
SP 5
OP 20
DO 10.1136/practneurol-2018-001899
VO 19
IS 1
A1 Daniel H Whittam
A1 Emma C Tallantyre
A1 Stephen Jolles
A1 Saif Huda
A1 Robert J Moots
A1 Ho Jin Kim
A1 Neil P Robertson
A1 Bruce A C Cree
A1 Anu Jacob
YR 2019
UL http://pn.bmj.com/content/19/1/5.abstract
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.