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Balancing the Risks and Benefits of Rituximab

Balancing the Risks and Benefits of Rituximab In this issue, Safa and Darrieux1 report a new and serious type of infection after rituximab therapy: cerebral toxoplasmosis. Although rituximab has helped many patients with lymphoma and autoimmune disease for more than 10 years, it has been linked to several major infectious complications.2 Reactivation of hepatitis B, cytomegalovirus disease, and the rare but fatal progressive multifocal leukoencephalopathy are the most infamous of these infections. Establishing a causal link between rituximab and infectious complications is difficult because most patients receive multiple immunosuppressants, consecutively or even concurrently. Rituximab can be impressively effective in some patients. More than 40% of patients with non-Hodgkin lymphoma3,4 respond and 30% of patients with rheumatoid arthritis5 improve with this drug, whereas only 1% experience serious infections.6 Balancing these rare but alarming adverse effects with the immediate benefits is not easy. As more patients are prescribed this drug, we must remain vigilant to posttrial data on complications and study ways to help patients and physicians make informed decisions that incorporate the rapidly expanding evidence base concerning potential adverse effects. References 1. Safa G, Darrieux L. Cerebral toxoplasmosis after rituximab therapy [published online April 15, 2013]. JAMA Intern Med. 2013;173(10):924-926Google ScholarCrossref 2. Kelesidis T, Daikos G, Boumpas D, Tsiodras S. Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis. 2011;15(1):e2-e1621074471PubMedGoogle ScholarCrossref 3. McLaughlin P, Grillo-López AJ, Link BK, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol. 1998;16(8):2825-28339704735PubMedGoogle Scholar 4. Davis TA, Grillo-López AJ, White CA, et al. Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin's lymphoma: safety and efficacy of re-treatment. J Clin Oncol. 2000;18(17):3135-314310963642PubMedGoogle Scholar 5. Singh JA, Christensen R, Wells GA, et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2009;(4):CD00784819821440PubMedGoogle Scholar 6. Singh JA, Wells GA, Christensen R, et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;(2):CD00879421328309PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Balancing the Risks and Benefits of Rituximab

Linos, Eleni
JAMA Internal Medicine , Volume 173 (10) – May 27, 2013
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References (13)

Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/jamainternmed.2013.743
Publisher site
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Abstract

In this issue, Safa and Darrieux1 report a new and serious type of infection after rituximab therapy: cerebral toxoplasmosis. Although rituximab has helped many patients with lymphoma and autoimmune disease for more than 10 years, it has been linked to several major infectious complications.2 Reactivation of hepatitis B, cytomegalovirus disease, and the rare but fatal progressive multifocal leukoencephalopathy are the most infamous of these infections. Establishing a causal link between rituximab and infectious complications is difficult because most patients receive multiple immunosuppressants, consecutively or even concurrently. Rituximab can be impressively effective in some patients. More than 40% of patients with non-Hodgkin lymphoma3,4 respond and 30% of patients with rheumatoid arthritis5 improve with this drug, whereas only 1% experience serious infections.6 Balancing these rare but alarming adverse effects with the immediate benefits is not easy. As more patients are prescribed this drug, we must remain vigilant to posttrial data on complications and study ways to help patients and physicians make informed decisions that incorporate the rapidly expanding evidence base concerning potential adverse effects. References 1. Safa G, Darrieux L. Cerebral toxoplasmosis after rituximab therapy [published online April 15, 2013]. JAMA Intern Med. 2013;173(10):924-926Google ScholarCrossref 2. Kelesidis T, Daikos G, Boumpas D, Tsiodras S. Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis. 2011;15(1):e2-e1621074471PubMedGoogle ScholarCrossref 3. McLaughlin P, Grillo-López AJ, Link BK, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol. 1998;16(8):2825-28339704735PubMedGoogle Scholar 4. Davis TA, Grillo-López AJ, White CA, et al. Rituximab anti-CD20 monoclonal antibody therapy in non-Hodgkin's lymphoma: safety and efficacy of re-treatment. J Clin Oncol. 2000;18(17):3135-314310963642PubMedGoogle Scholar 5. Singh JA, Christensen R, Wells GA, et al. Biologics for rheumatoid arthritis: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2009;(4):CD00784819821440PubMedGoogle Scholar 6. Singh JA, Wells GA, Christensen R, et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Database Syst Rev. 2011;(2):CD00879421328309PubMedGoogle Scholar

Journal

JAMA Internal Medicine – American Medical Association

Published: May 27, 2013

Keywords: toxoplasmosis, cerebral,rituximab

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