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Do you take Rituximab?
Patients taking rituximab should be aware that the FDA has reported that two systemic lupus erythematosus patients developed a lethal brain infection called progressive multifocal leukoencephalopathy (PML) after having received rituximab.This condition is due to reactivation of a virus of the polyoma group (JC virus) that is always present but generally remains dormant in the body.The reactivation of the JC virus also has occurred in lupus patients whonever received rituximab and have received other immune suppressive medications.The actual risk (if any) for development of PML remains unknown as the lupus patients were treated "off label"; and, thus, the number of lupus patients who have received rituximab can only be estimated.
PML has been reported in non-Hodgkin's lymphoma patients who received rituximab.It also has been diagnosed in patients with HIV, Wegener's granulomatosis, and rheumatoid arthritis.It has also been reported in multiple sclerosis patients receiving a biologic drug called natalizumab (Tysabri).
The most common symptoms of PML include paresis (incomplete paralysis affecting motion but not sensation), cognitive dysfunction, and ataxia (irregularity in the function of the muscles).An MRI may show non-contrasting-enhancing white matter lesions of the brain.The JC virus may be detected in cerebrospinal fluid by polymerase chain reaction.The sensitivity and specificity of these tests in PML are unknown.
As usual, physicians and patients must be aware that the risks of therapy need to be carefully weighed against the benefits.It is currently unknown whether rituximab increases the risk of PML, but this must be kept in mind as new therapies are evaluated.
