Rituximab

Here's the info on Rituximab, Kris. I wish it were more encouraging, given the decision you're all facing. It’s been used since 1997 to treat lymphoma and rheumatoid arthritis, by killing B cells of the immune system. These cells cause inflammation when they attack foreign intruders in the body. However, in auto-immune system diseases like scleroderma, they attack the body itself. Reducing B cells has the advantage of reducing their attack on the body, but the disadvantage of reducing their ability to protect the body by fighting off infections. The brand name for this drug is Rituxan, and it is given intra-venously over a period of a few hours. Usually it is administered once a week, but perhaps Dr. Furst has found a more effective schedule for scleroderma.

Unfortunately, Rituximab has an extremely long list of side effects and chances of fatal complications in patients with heart rhythm, lung, or kidney problems. It cannot be given to patients who have an active infection, recent live vaccines (including flu), or are on medications to suppress the immune system or reduce high blood pressure. Visitors who have had recent live vaccines also pose a danger to the patient. I believe Bill falls into several of these categories, so this drug might be very dangerous for him.

The most common of the many side effects is fever, rigors, and chills experienced by more than 80% of patients. These effects are severe in 4-7 out of every 10,000 patients. “Other common side effects related to rituximab are nausea, hives, fatigue, headache, itching, difficulty breathing due to bronchospasm, a sensation of swelling of the tongue or throat, runny nose, vomiting, decreased blood pressure, flushing.” (The Mayo Clinic lists another 20 or 30 side effects in addition to these.) Bill is in such weak condition that any side effect could be quite serious.

The most frightening quote was on the Medicine Net site: “WARNING: Rituximab may infrequently cause serious (sometimes fatal) side effects including severe breathing problems (e.g., hypoxia, pulmonary infiltrates, acute respiratory distress syndrome) or heart problems (e.g., heart attack, irregular heartbeat, low blood pressure).” I worry that such complications, if not outright fatal, would cause Bill more suffering.

As always, I hope fellow bloggers with medical backgrounds will correct any misinterpretations I might have made.

http://www.mayoclinic.com/health/drug-information/DR601789

http://www.medicinenet.com/rituximab/article.htm

My heart and thoughts are with you all.

--Janet