Walton – Rituximab in Neurological Disease: Principles, Evidence and Practice

Author(s): Whittam D.H.; Huda S.; Jacob A.; Tallantyre E.C.; Robertson N.P.; Jolles S.; Moots R.J.; Kim H.J.; Cree B.A.C.

Source: Practical neurology; Feb 2019; vol. 19 (no. 1); p. 5-20

Publication Date: Feb 2019

Publication Type(s): Article

PubMedID: 30498056

Available  at Practical neurology –  from BMJ Journals – NHS

Abstract: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.

Copyright © Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

Database: EMBASE

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