Is It Lupus Chemo?

INTRODUCTION

Before diving into this blog topic, I thought I knew the exact waters I was entering.  I mean, pretty clear in my mind, Rituxan is “lupus chemo” right?  Many of you (like me), may be shocked to find out that although Rituxan is used to treat cancer, it is not classified as a chemotherapy drug.   WHATTTT?  So, if it’s not a “chemo” drug then, what is it?  And how does it work?  And why does it seem so ominous when our doctors prescribe it to us?  This blog, will hopefully, answer all those questions and more!

WHAT IS IT?

Rituxan (rituximab) is a genetically engineered molecule, extracted from an antibody from a mouse (thanks Mickey!) that is designed to attack and kill B lymphocytes, otherwise knows as B cells.  B cells are white blood cells that develop from stem cells in the bone marrow.  They are partly responsible for autoantibody production and partly responsible for certain proteins that can raise the levels of inflammation in the body.  Now, B cells are a part of the normal makeup of the immune system, however in people who have lupus, or rheumatoid arthritis, and other autoimmune diseases, they can be overactive.  BIG SHOCK, I know!  These overactive autoantibodies can attack other cells as foreign invaders and that can damage the body’s tissue.

Developed by Genentech/IDEC, Rituxan was originally created to help those suffering from non-Hodgkin’s lymphoma and chronic lymphocytic leukemia and was deemed a new type of targeted cancer therapy.  Which is primarily why many people think it is a form of “chemotherapy.”  But what makes it NOT a chemotherapy drug is the fact that it is a monoclonal antibody (an identical immune cell that is a clone of a unique parent cell) and it works in a different way to find and attack cells, whereas traditional chemotherapy uses a combination of drugs called cytostatics, which aim to stop cells (any cells not just monoclonal antibodies) from continuing to divide uncontrollably.  Monoclonal antibody therapy, like Rituxan is only useful it targeting a specific antigen or cell that has been identified.  And it is usually only used for short term use and is not recommended as a replacement for traditional chemotherapy.

Okay, so now that we know the difference between Rituxan and traditional chemotherapy, let’s talk about why your doctor may recommend it if you are suffering from lupus or rheumatoid arthritis.

As stated above, people with lupus or rheumatoid arthritis can suffer from an overabundance of B cell production.  When this happens, the cells can mistake the good cells in our bodies as invaders and go into attack mode. That is when levels of inflammation rise and symptoms and a patient may experience a flare. Rituxan is used to target the overproduction of B cells and hopefully stop the disease from progressing and causing pain and other issues.

Interestingly enough, the FDA has not approved of Rituxan as a lupus treatment. Although it has been approved to treat rheumatoid arthritis and vasculitis.  This is primary due to not enough clinical trials and issues with the trial design.

WHAT TO EXPECT WHEN YOU START RITUXAN

Rituxan is administered as an IV infusion (through the vein) usually every 4-6 months, but can be given in different interval dosing.  The infusions are done in a hospital, doctor’s office or infusion center and are typically around 4-6 hours.  You will be monitored closely, so if any reaction occurs, the infusion can be slowed or stopped.  Some of the more common side effects or reactions include chills, fever, itching (with or

without hives), dizziness, lightheadedness, nausea and coughing. During your interval dosing, your blood levels will be checked because Rituxan can lower certain blood cell counts.  The drug is often given with methotrexate and steroids, so make sure you ask your doctor about the side effects of those medications as well.

Tips to making your infusion more comfortable:

• There are no dietary limitations before treatment, so eat well before and bring a snack.
• You may get bored, word searches, headphones, adult coloring books and a good novel will help you pass the time.
• Bring a neck pillow, small blanket and slippers if you want to get cozy and take a nap.

WHAT YOUR DOCTOR NEEDS TO KNOW BEFORE YOU START

It is important to review the Rituxan Medication Guide before starting infusions.  It is imperative to tell your doctor if you have tried Rituxan in the past and if you had a previous reaction to it.  Also, discuss if you have a history of having heart problems, chest pain, lung and kidney problems or if you currently have an infection.  If you are pregnant or planning to become pregnant, this is not a safe drug to be on.  It is also not safe for breastfeeding mothers.  Make sure your doctor has an accurate list of every medication and supplement you are currently taking, as well as, any recent vaccines you may have been given.

HAD YOUR FIRST INFUSION, NOW WHAT?

After your first treatment with Rituxan, you may think to yourself, “Okay, what now?  How long before I feel any results?”  There have been studies where people who were seen only weeks after their first infusion saw improvement in their symptoms.  Although, individual results vary, Rituxan has been shown to provide up to 6 months of symptom improvement.  In fact, in a study on the Genentech website, 51% of people using the medication reported lessening of symptoms.  This is good news if you are suffering from the crippling pain of rheumatoid arthritis.  Many doctors feel positively about the use of Rituxan for certain manifestations of lupus and further clinical research is being pursued to see how these infusions help long term with SLE.

Once you have decided that you can tolerate the infusion and you see a possible improvement in your symptoms, your doctor most likely will want to schedule your next dose.  It is usually done twice a year, however, some patients have it every 4 months.

Based on your health and how well you are feeling, you and your doctor can discuss together if you should start another course of treatment.

In Conclusion

Like all treatments, there are pro’s and con’s.  But you have to trust your doctor on this one.  If your doctor has suggested you start Rituxan treatments, it is because he/she believes that the benefits of the infusion outweigh the possible side effects.  It is okay to be a little nervous, anytime you branch into the unknown, it can be scary.  It is also okay to ask a lot of questions.  But know that your doctor has taken an oath to help you, and if this is what he/she feels will help, it is worth listening to them.  And never forget, you have us, Kaleidoscope Fighting Lupus, there supporting you as well.

Author:  Kelli Roseta

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