Elevated CRP after Rituxin

[dutch]

Hello,
My son had his second large dose of RTX 2 weeks ago and now has elevated CRP and ESR. Has anyone ever had this happen? His doctor is asking for weekly labs to monitor and is considering a third dose. I know he needs 8 weeks to get the benefit, but I am trying to figure out what is causing inflammation if his b cells are depleted. Any insight?

[Al]

Hello,
My son had his second large dose of RTX 2 weeks ago and now has elevated CRP and ESR. Has anyone ever had this happen? His doctor is asking for weekly labs to monitor and is considering a third dose. I know he needs 8 weeks to get the benefit, but I am trying to figure out what is causing inflammation if his b cells are depleted. Any insight?

I haven't had direct experience with RTX (yet), so I will defer to the many forum members who have. But I think two weeks is not enough for the RTX to severely deplete the B cells. And even then, there are a lot of antibodies in the system that need to be cleared before inflammation goes down. This is why massive amounts of prednisone are usually called for. I think (again, others have more experience with this) that the usual RTX protocol calls for four infusions. Does this help?

Al

[dutch]

Thanks. I am hoping we see progress by next Monday. He is home from college so maybe TLC and home cooking? RTX is either given in 4 weekly lower doses or 2 biweekly large doses. I know it takes 8 weeks for most to see/feel the effects, but am concerned about the effects of walking around with so much inflammation, as evidenced by elevated CRP, etc.

[ScreaminMeanie]

As Al said, most likely the rtx hasn't had a chance to do its magic yet. I know it's a small sample, but it seems to me the people here who've had the 4-dose protocol seem to be doing better than the people who've had the 2-dose protocol. In my case, it took about 8 weeks before there were noticeable results (bloodwork-wise) from the rtx, but it's been pretty smooth sailing ever since (I'm six months post-rtx at this point, and all my bloodwork is normal and I have no WG symptoms at the moment).

[dutch]

Thanks. I will just try to be patient, something I am not good at! I guess it is one of the many things I will learn along this journey. Karen

[Sangye]

Since it takes rtx 6-8 weeks to start working, the increased CRP and ESR may be a reflection of Wegs activity continuing to increase.

Prednisone helps to keep control of disease activity while the main immunosuppressant gets up to speed. What daily dose of pred is your son taking? It might not be high enough if he has severe disease activity.

[dutch]

Do you mind me asking how high your numbers were?