Starting maintenance meds after Rituxn

[Middlesista]

Just reading a few posts and have a question. Are folks who complete their 4 Rituxin treatments usually on meds other than Prednisone and say Bactrin soon after finishing Rituxin? How soon are maintenance meds started r/t Rituxin? I have read that some folks have results immediately after Rituxin where as other folks say it takes weeks to months? I know everyone is different but was just looking for some insight


Thanks!

[lesa]

Hi Middlesista,

During and after my 4 Rituxan infusions I was on Methotrexate. A lower dose during my infusions and now a higher dose after. I am still on Methotrexate and it has been 17 months since my infusions. My results from the Rituxan/Methotrexate took several months. I started noticing things had changed 2-4 months after. Everyone is different and every doctor is different. This has worked well for me. My labs have been normal for months now. The tricky part in my future is weaning off of the Methotrexate. That may take place this summer and very slowly:)

Hope this might help!
Best to you.

[Middlesista]

Thank you Lesa

[debra]

My sista, stuck in the middle, just want to wish you luck... I can't help, as I seem to be taking the all natural approach with my dog... Not by choice as you are aware sista... Hey if laughter really is the best medicine, I will have put the weg dog down pretty quick..... Deb.

[Middlesista]

RA gave me a research article about the use of Rituxin for Remission Induction and Maintenance. From 2012. One bit of info mentioned the importance of PCP prophylaxis for duration of B cell depletion following RTX infusion in folks with GPA

[debra]

Sista, stuck in the middle, thank you. Maybe I'll be treated with this someday, just like my sister Alysia, who's also my mother, and really special friend..... I know this is her thing.... Deb.

[kaysee]

I was not given any maintenance drugs after my RTX treatments. It's been 15 months now since my last RTX and I have not had a flaur. My blood work is checked a few months and is looking fine.

[Middlesista]

That is great Karen!! I hope I can follow your lead!

[MaxD]

About 6 months after my first RTX treatments I tapered off prednisone. At that point I stopped taking Bactrim as well. No meds after that. My docs then started checking my peripheral B-cell counts along with the standard blood work. When the B-cell count went above 0, I had one infusion for maintenance therapy. That was 10 months ago, and my B-cells remain at 0. I will get another infusion when it goes above 0. Dr Spiera plans to continue RTX therapy for the first two years after initial treatment. Beyond two years, and barring any flares, let's see what he says. From what I understand, every case is different and maintenance therapy is an art and different docs follow different procedures.

Good luck as you get closer to remission! It is a strange thing - I felt worst before diagnosis and then again for 9 months after the prednisone was down to 8mg. But now I feel fine and hope to stay that way.

[Middlesista]

ThanksMax - glad to hear you are doing better!

I see that it took you 6 months to come off Prednisone - I am wondering what your titration schedule looked like. My RA said 10 mg a week till I get to 20mg and I was t 40mG I think that is a bit too fast

[MaxD]

After one month I went from 75 to 60 (RTX that day), then every 2 weeks tapering down to 40, 30, 20, 17.5, 15, 12.5, 10, 7.5, 5, back up to 7, then down by 1 every other week. I started feeling achy and stiff on first descent to 7.5, much worse at 5 - so we went back up to 7 and tapered it more slowly. Dr Spiera said he was being a little too aggressive with the taper but he really wanted me off prednisone as quickly as possible so after going up to 7 he recommended I just get through the pains as best I could. 9 months was enough!

Unless you notice a huge difference as you taper by 10mg down towards 20, no reason to be nervous. Your body will let you know!

[Middlesista]

Thanks Max!