MabThera® (rituximab)

What is it?

Monoclonal antibodies are used to try and destroy some types of cancer cells while causing little harm to normal cells. They are designed to recognise certain proteins that are found on the surface of some cancer cells. The monoclonal antibody recognises the protein and locks onto it (like a key in a lock). This may then trigger the body's immune system to attack the cancer cells and can sometimes cause the cells to destroy themselves.

MabThera locks onto a protein called CD20, which is found on the surface of one of the main types of normal white blood cells (B-cell lymphocytes). It is also present on the surface of most of the abnormal B-cell lymphocytes, which cause certain types of low-grade non-Hodgkin's lymphoma. MabThera acts by attacking both malignant and normal B-cell lymphocytes. However, the body quickly replaces any normal white blood cells, which are damaged, so the risk of side effects from this is very small.

Before you take it

You should not receive this medicine if you have had an allergic reaction to MabThera.

If you plan to have children: Do not get pregnant while you or your husband / wife are receiving MabThera. Use an effective method of birth control while you are getting this medicine and for up to 12 months following your last dose.

If you are pregnant or breastfeeding, talk to your doctor before you start your treatments. If you become pregnant, tell your doctor right away.

How to take it?

MabThera is given as a drip (infusion) into the vein through a fine tube inserted into the vein (cannula). Some people can have an allergic reaction to MabThera (see Possible side effects) and to reduce the risk of this the first dose is given slowly over a number of hours. You will be given some drugs before the treatment is given to prevent this. If you do have a reaction, the infusion can be stopped and started again when the symptoms are over.

You may need to stay in hospital overnight for the first treatment so that you can be monitored. After that it can usually be given in the outpatients department and over a shorter period of time. MabThera is usually given weekly over a period of four weeks. The treatment may be repeated later if needed.

Possible side effects

The side effects of MabThera are generally mild and some of these can be reduced with medication. Side effects can begin during the first dose of the drug and continue for a few hours afterwards, but are usually milder with following doses. The most common side effects are:

Flu-like symptoms. This can include fever and chills, weakness, muscle aches, tiredness, dizziness and headache. These can occur while the drug is being given, but do not usually last long.
Low blood pressure. This may happen during the infusion so your blood pressure will be regularly checked. People who normally take drugs to lower their blood pressure may be advised by the doctor to take these at least 12 hours before MabThera is given.
Feelings of sickness (nausea) and occasional vomiting. There are now very effective anti-sickness drugs to prevent or substantially reduce this. If the sickness is not controlled, or continues, tell your doctor. They can prescribe other anti-sickness drugs which may be more effective.
Mild pain in parts of the body where the cancer has spread. Painkillers can be given to relieve this.
Allergic reactions. It is not unusual to have a slight allergic reaction to MabThera. Signs of this include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and shortness of breath. You will be monitored closely during your treatment but do tell your nurse or doctor if you have any of these symptoms. To reduce the chance of developing an allergic reaction certain drugs (antihistamines) can be given before the infusion. The infusion can also be slowed down or stopped until the reaction is over.
Flushing. You may experience sudden warmth in your face and some redness of the face. This can happen for a short period of time during the infusion.

MabThera may worsen heart problems in people who already have these. For this reason it is used with caution in anyone with a history of heart disease.

Storing it

You will receive this medicine while you are in a hospital or chemotherapy treatment center.

MabThera solutions for infusion may be stored at 2-8 C (36-46 F) for 24 hours.
MabThera solutions for infusion have been shown to be stable for an additional 24 hours at room temperature. However, since MabThera solutions do not contain a preservative, diluted solutions should be stored refrigerated (2-8 C).

Further information

For answers to specific healthcare questions or concerns, Roche recommends consulting your physician or professional healthcare provider