Anyone only use rituximab for remission?

[mrtmeo]

I have not been able to find anyone who only used rituximab for induction to remission.
I have only seen people who had cytoxan first and then rituxan.

Anyone have success with only rituxan?
If so, how long did it take to reach remission?
Did you use a maintenance drug after rituxan?

[kaysee]

I was just diagnosed in April 2014. I was put on prednisone only until the insurance approved the rituxan infusions. I had my first rituxan treatments through June/July. Four treatments - one each weeks for 4 weeks. My kidney function went from 25% to 50% after the treatments and most of the blood test results returned to normal. We started to decrease the prednisone by 5 g every 7-10 days and mid August I was off prednisone for two weeks. I imediately had a flare up of the WG not being on any maintenance drug. I was told that rituxan can be adinistered only at 4 month intervals, so I am scheduled for those to start again Sept. 29. In the meantime I am back on prednisone (30 g) and was hospitalized for 4 days having pulse steroid infusions. Those are very high doses of steroid infused once a day. I had 3 days at 125 mg with not change to my kidney function. I then had 500 mg for three days and the kidney function started to improve. We are trying to reach remission with the rituxan so that I can get off the prednisone. I have had no other drugs for the WG to date. I have had to start Lisinopril for high blood pressure and a water pill which is not helping much.

[mrtmeo]

I was just diagnosed in April 2014. I was put on prednisone only until the insurance approved the rituxan infusions. I had my first rituxan treatments through June/July. Four treatments - one each weeks for 4 weeks. My kidney function went from 25% to 50% after the treatments and most of the blood test results returned to normal. We started to decrease the prednisone by 5 g every 7-10 days and mid August I was off prednisone for two weeks. I imediately had a flare up of the WG not being on any maintenance drug. I was told that rituxan can be adinistered only at 4 month intervals, so I am scheduled for those to start again Sept. 29. In the meantime I am back on prednisone (30 g) and was hospitalized for 4 days having pulse steroid infusions. Those are very high doses of steroid infused once a day. I had 3 days at 125 mg with not change to my kidney function. I then had 500 mg for three days and the kidney function started to improve. We are trying to reach remission with the rituxan so that I can get off the prednisone. I have had no other drugs for the WG to date. I have had to start Lisinopril for high blood pressure and a water pill which is not helping much.

Hi Kaysee,
It sounds like they tapered your prednisone too quickly.
Did they taper your prednisone due to ANACA and PR3 values?

In the trials they would taper the prednisone within 6 months of starting Rtx, but depends on flares.
Hopefully, the 2nd rtx will get u into remission.

My mom's timeline is similar to yours, but she is still on 10mg prednisone and her dr wants her on Imuran, but she is anemic and the imuran suppresses the bone marrow.
It sure seems like my mom's kidneys are in a flare too, but won't know until we get the lab work again.
She has not become ANCA negative, yet.

[WG mom]

Does it typically take more than one treatment series to realize results? My daughter completed the four infusions mid August. Her doc has reduced prednisone from 40mg to 20 (over a month period). She is having headaches which don't respond to traditional OTC meds and the doc says he can't prescribe something stronger because of her other meds. She's trying to tough it out because she really wants off the prednisone due to weight gain.
Perhaps we were naive in thinking the rtx would be a miracle drug.
So, anyone gone into remission after one series or do we need to look at another one in a few months?
Thanks.

[mrtmeo]

Does it typically take more than one treatment series to realize results? My daughter completed the four infusions mid August. Her doc has reduced prednisone from 40mg to 20 (over a month period). She is having headaches which don't respond to traditional OTC meds and the doc says he can't prescribe something stronger because of her other meds. She's trying to tough it out because she really wants off the prednisone due to weight gain.
Perhaps we were naive in thinking the rtx would be a miracle drug.
So, anyone gone into remission after one series or do we need to look at another one in a few months?
Thanks.

Hi WG Mom,
From all the studies I have read, it takes 3-6 months to reach remission.
My mom is 3 months off her first rtx induction and trying to reach remission, but it is a long wait.
If she doesn't respond by the 6th month or has a major flare before that, you can ask your dr for help in determining whether to do another treatment.
As far as headaches, could it be the prednisone reduction?
How long have the headaches been going on?
You could create a thread to find out if anything works for headaches.

[Bing505z]

Does it typically take more than one treatment series to realize results? My daughter completed the four infusions mid August. Her doc has reduced prednisone from 40mg to 20 (over a month period). She is having headaches which don't respond to traditional OTC meds and the doc says he can't prescribe something stronger because of her other meds. She's trying to tough it out because she really wants off the prednisone due to weight gain.
Perhaps we were naive in thinking the rtx would be a miracle drug.
So, anyone gone into remission after one series or do we need to look at another one in a few months?
Thanks.

I am in remission after one Rituxan series. My Doc took me off Pred' about a month after my last dose of Rituxan (was reducing every week during treatments). I responded very well to the treatment. As for the pain management, I used hydrocodone and toradol while using other med's without any problems. Just know this, everyone responds differently to treatments so it may take another month or so. I know it's difficult to stay positive during these tough times, but try and stay strong and encourage your daughter. I do hope she recovers soon.

[WG mom]

Thanks, mrtmeo. It helps to have a realistic timetable. I will take your suggestion and do a post about the headaches. Much appreciated.

[mrtmeo]

Hi Bing,
What were the indicators that you were in remission, ANCA, PR3?

[Bing505z]

Hi Bing,
What were the indicators that you were in remission, ANCA, PR3?

Vasculitis Speacialist uses these :
· Sedimentaion Rate-Westergren
· C-Reactive Protein, Quant
· Anca Panel (MPO, PR-3, C-Anca, P-Anca, andAtypical pAnca)
· CBC Panel with Differential/Platelet
· Comp. Metabolic Panel (14)
· Kidney Function
· Reports including Images from Lung Doc and from ENT

[mrtmeo]

Thanks Bing!