Is there a connection between RTX and lung infections ?

[Alysia]

Hi,
we really enjoy our rtx, if I can say so
but yesterday at the hospital, during my IV, I was told by another woman who also got it (for Scleroderma) that she got 3 lungs infections this year and that the docs told her that it was caused by rtx STILL she is getting it, but only 500mg and no more 1000mg.
so I though to ask you, who knows anything about it, and also search the web.
here is a link that I found:
http://www.ersj.org.uk/content/35/3/681.full
I copy the conclusions:
In conclusion, the present study confirms the pulmonary toxicity of rituximab. Our data should prove helpful to clinicians in assessing causality in patients with respiratory symptoms following rituximab therapy. Three distinct clinical presentations were identified according to time to onset, suggesting different underlying mechanisms. For each, we suggest specific recommendations. Pulmonologists must ensure the early diagnosis and treatment of rituximab-induced lung disease and inform other specialists of this complication and of the need for close monitoring of respiratory status.

there are more articles suggesting it, like this:
http://www.nejm.org/doi/full/10.1056...00306263482619
it seems that overall it increases infections (as I can tell from my experience), like in the following links :
Does rituximab increase the incidence of infectious complications? A narrative review
http://www.iwmf.com/docs/rituximab-a...hematology.pdf
please, do not read it before going to sleep
the consolation is that it is written that complcations are rare.
and we can't do without it... (sigh)

[Pete]

Intuitively, we should expect to be more susceptible to infection while immunosuppressed, no matter what drug we use. Certainly good hygiene and staying away from people with colds, flu, etc., should reduce our chances of getting sick.

[Debbie C]

Alysia, I personally think all these drugs prescribed for not only this but other diseases surely have other effects on the body. If you were too look at all the possible side effects ( which I usually do ) you wouldn't take them ( which I usually don't ) I can't understand the need for rtx infusions ( when it is such a powerful drug ) if one is in remission or there are no huge signs of the illness. Like the saying goes " if it's not broke don't fix it ". Maybe you should ask your dr. about it,maybe that's why you keep getting uti's ...it gotta come out somewhere !!! Hope you are better soon....Hugs

[annekat]

Thanks for finding the links, Alysia, and sharing a conclusion. It is true that we are all taking risks with any of the drugs we take. I understand your concern, and we can only hope that you and others on here who are taking RTX will be in the majority who do not have these problems. I'm sorry you have to worry about this while trying to get better...

[Geoff]

Gosh this has made me sit up with a jolt. I was DX 6 years ago and have been amazed that apaft from ONE cold, i have enjoyed a relatively germ free life.
In feb this year i finished my 2 year cycle of RTX. There were a few questions raised beford the last IV and Dr Jayne did ponder the opinion that perhaps i had had too much rtx in the time. Given my size, 6'4" and 18 stone, i was infussed every 4 months.
Be that as it may, i now find 2 months later i am struggling to shake off the worst chest infection i have ever had, and the 2nd to boot! I have finished another round of antibiotics and got the all clear from my GP on tuesday who confirmed my lungs were 'clear'.
Thing is do i now flag this up to Addenbrookes or carry on with my recovery and wait till June for my next appt? I thought i knew the answer but this latest info from Alysia has raised concerns.

[Debbie C]

Before my first and only infusion, I read a pamplet on all that can happen within just minutes of getting this so surely repeated infusions can reak haffeck on you. I know it is the " wonder drug " but now it make you "wonder " in different ways.
Geoff, I would ask if the infection could possibly be from the infusion. That could be an answer to alot of peoples problems...too much of a good thing !!!!

[pberggren1]

I just had an infusion of RTX last month and came down with a lung infection shortly after.

[me2]

At my doc visit a few days ago he expressed very vocal concern about me dying from infection based on the all the imunosuppresants I am on. Prednisone, methotrexate, and Rituxan.
The only infection I have had was persistant Staph in my sinuses. I had surgery to help with this. So far I seem better.
I lead a fairly isolated life from people and take reasonable precautions when in public- like hand washing during and after being out. I know not everyone can live this way.

[pberggren1]

What specialty is your doc Kirk? Do you have damage to your lungs? Was he referring to a specific area like the lungs?

[me2]

Hi Phil, this doc is my Rheumy who oversees my general care for several years now. I do not have significant damage to my lungs (although they are not exactly normal). He did not mention a specific area that I might be prone to infection but if I had to guess it would be lungs- even for me.

This is where we take in bugs and they can get a foothold easily in that nice warm, moist incubator. Its just my thoughts on this, I don't really know.
I would also suspect that we would be prone to infection wherever we have the most damage. I recently had surgery on my very bad sinuses and they were filled with Staph.
My Rheumy said this was not surprising for a WG patient.