Earlier this year the National Institute of Health and Care Excellence (NICE) issued new guidelines regarding the use of rituximab, also known as mabthera, in treating Wegener's Granulomatosis (GPA).
After a consideration period of almost a year, NICE concluded that rituximab, used in conjunction with steroids, is an option for treating ANCA vasculitis. NICE had originally rejected the use of rituximab to fight ANCA vasculitis.
Vasculitis UK campaigned vigorously to have that original decision overturned, and they successfully helped to show that rituximab was not just as good as conventional treatment, but is superior for many patients. I certainly know this to be true in the case of my wife Alicia, as the rituximab was the only treatment that worked for her after everything else failed.
Vasculitis UK Chairman, John Mills, stated:
"We are very pleased with this final decision, which meets with most, but not quite all of our objectives. We are proud to have been able to have a significant impact on the Committee’s decision. This demonstrates that the patient voice can influence decisions that will have far reaching benefits for many vasculitis patients who might otherwise have been denied the benefits of this beneficial new drug. It also demonstrates the value of working together with medical professionals – a perfect example of patient and professional teamwork”.
There are some caveats on the use of rituximab.
It can only be used where one or more full courses of cyclophosphamide have been tried and further use of chemotherapy drugs would exceed the maximum safe lifetime cumulative dose of 25 gms. This requirement is waived in cases where the patient cannot take cyclophosphamide for some reason.
As Alicia knows, cyclophosphamide can affect fertility, so in cases where a person has not completed their family they may take rituximab instead.
Rituximab can also be taken where the cyclophosphamide has failed to control the disease and where there are bladder and other urinary tract issues.
Rituximab has not been approved as an initial treatment for Wegener's Disease. Nor is it approved for relapses, except where other drugs have previously failed and further cyclophosphamide would exceed the safe dose. Finally, rituximab cannot be used as part of a maintenance regimen.
If you are currently receiving rituximab treatment as part of your NHS care, and your use of the drug falls outside of the recommended use, DON'T WORRY! You can still receive rituximab as long as your clinician considers it a necessary part of your treatment.
You can read more about the NICE decision on the V-UK website.
Main image courtesy of Striatic.