Medication | Effect on immune system | Associated infections* | Pre-treatment testing¶ | Pre-treatment vaccinationsΔ | Comments |
Rituximab | Induces apoptosis of CD20+ B cells leading to disruption of B and T cell interaction. | Bacterial:
Viral:
Fungal:
| Test for:
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|
Ocrelizumab | |||||
Ofatumumab | |||||
Belimumab | Prevents stimulation of B cells but does not deplete them as the other agents do, leading to less risk of severe infection. |
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COVID-19: severe coronavirus disease 2019; CMV: cytomegalovirus; EBV: Epstein-Barr virus; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; JCV: John Cunningham virus; PML: progressive multifocal leukoencephalopathy; RZV: recombinant (non-live) zoster vaccine (Shingrix); TBI: tuberculosis infection.
* In addition to the infections listed, typical, common bacterial and viral infections should also be considered in the differential when infection is suspected in a patient taking the specified agent.
¶ For patients who do not have a negative HIV test documented in their records or are at increased risk of acquiring HIV (eg, men who have sex with men, engagement in sex work), the pre-treatment infectious testing process is a good opportunity to provide routine HIV screening prior to the initiation of immunosuppression. Treat any infections found on pre-treatment testing. Control of infection should be demonstrated prior to initiating immunosuppressive therapy.
Δ Live and non-live vaccines should be administered no later than 4 and 2 weeks, respectively, prior to initiating therapy. Vaccine responses may be attenuated while on therapy and for 6 to 12 months after cessation of therapy.
◊ Risk of pneumocystis pneumonia in patients taking rituximab for non-malignancy medical conditions is unclear. Pneumocystis pneumonia prophylaxis may be indicated when rituximab is used for certain conditions, such as vasculitis. Refer to UpToDate text on Pneumocystis pneumonia prophylaxis in patients without HIV for further details.Do you want to add Medilib to your home screen?