Rituximab
Rituximab was the first antibody ever approved for cancer (1997). It made chemoimmunotherapy the CLL standard for a decade, and biosimilars keep it cheap and everywhere.
Overview
Approved in follicular lymphoma (1997), DLBCL (2006, R-CHOP), CLL (2010, with fludarabine-cyclophosphamide: FCR, the first regimen to show OS benefit in CLL). Superseded in CLL by targeted agents (CLL13, CLL14, ELEVATE-TN) but still used with venetoclax in relapse (MURANO: venetoclax-rituximab 24 months) and in resource-limited settings. Biosimilars (Truxima, Ruxience, Riabni) since 2018.
Chimeric type I anti-CD20 IgG1: CDC, ADCC, and modest direct signalling. Connects to CD20.
1.Binds CD20 and clusters it into lipid rafts
- Route
- IV or subcutaneous (Rituxan Hycela)
- Schedule
- CLL: 375 mg/m² cycle 1 then 500 mg/m² cycles 2-6 with chemotherapy or venetoclax
- Monitoring
- Infusion reactions, HBV reactivation (boxed), PML (boxed), late-onset neutropenia
Source: US prescribing information (DailyMed). Doses are for orientation; the current label governs.
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS J9312 for Rituxan; biosimilars Truxima, Ruxience and Riabni have their own codes. Rituxan Hycela (subcutaneous) is Part B.
- Commercial insurance
- step therapy common
Preferred rituximab biosimilar required by most commercial medical-benefit programmes; prior authorisation confirms CD20-positive disease.
- Assistance programmes
- Genentech Access Solutions
- Genentech Patient Foundation: Free medicine for eligible patients regardless of insurance type.
- PAN Foundation: Disease-specific co-pay and premium funds; open and closed funds change monthly.
- HealthWell Foundation
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation Co-Pay Relief
- Leukemia & Lymphoma Society financial support
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B) · FDA: Biosimilars. Not medical or financial advice; verify with your plan.
- Appraised for
- Aggressive (diffuse large B-cell) non-Hodgkin lymphoma with CHOP
- Notes
- Follicular lymphoma (TA110, TA137, TA226), CLL (TA174, TA193). Biosimilars since 2017 dominate NHS use. Subcutaneous form available.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA65 · SMC advice: rituximab. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 1997 | Relapsed follicular lymphoma; first antibody approved for cancer |
| US | 2010 | CLL with fludarabine and cyclophosphamide |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Infusion-related reactions (first infusion) Historic lymphoma data; lower with premedication | 77% | - |
| Hepatitis B reactivation Boxed warning; screen all patients | - | - |
| Late-onset neutropenia | 8% | - |
Rates read from the US prescribing information. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topTrials recruiting now
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Latest papers
topQuery for this drug: (TITLE:"Rituximab" OR ABSTRACT:"Rituximab" OR TITLE:"Rituxan" OR ABSTRACT:"Rituxan" OR TITLE:"MabThera" OR ABSTRACT:"MabThera" OR TITLE:"and biosimilars" OR ABSTRACT:"and biosimilars" OR TITLE:"Rituximab and Hyaluronidase Human" OR ABSTRACT:"Rituximab and Hyaluronidase Human" OR TITLE:"Rituxan Hycela" OR ABSTRACT:"Rituxan Hycela") AND (radiopharmaceutical OR radioligand OR radionuclide OR theranostic OR "nuclear medicine" OR "molecular imaging" OR radiotracer OR scintigraphy OR cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Rituximab, not a curated reading list.
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