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Rituximab in neurological disease: principles, evidence and practice

Whittam, Daniel H, Tallantyre, Emma C ORCID:, Jolles, Stephen, Huda, Saif, Moots, Robert J, Kim, Ho Jin, Robertson, Neil P ORCID:, Cree, Bruce A C and Jacob, Anu 2019. Rituximab in neurological disease: principles, evidence and practice. Practical Neurology 19 (1) , pp. 5-10. 10.1136/practneurol-2018-001899

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: BMJ Publishing Group / Blackwell Publishing
ISSN: 1474-7758
Date of First Compliant Deposit: 4 February 2019
Date of Acceptance: 20 August 2018
Last Modified: 07 Nov 2023 13:48

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