From the Guidelines
Yes, prednisone can be used with rituximab, as evidenced by studies where rituximab has been used in combination with systemic corticosteroids, including prednisolone, which is similar to prednisone. This combination is utilized in the treatment of various conditions, including autoimmune disorders. According to the British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017 1, rituximab has been used as part of combination therapy, including systemic corticosteroids. The use of prednisone with rituximab is supported by the fact that in studies, a significant percentage of patients treated with rituximab also received adjuvant corticosteroids and/or immunosuppressants, with some studies employing rituximab together with prednisolone alone to good effect.
Key points to consider when using prednisone with rituximab include:
- The potential for enhanced immunosuppression, which may increase the risk of infections
- The need to monitor blood glucose levels due to the risk of hyperglycemia associated with prednisone use
- The importance of adjusting the dose of prednisone based on the individual patient's response and the specific treatment protocol being used
In terms of specific dosing, while the provided evidence does not detail exact prednisone dosages used in combination with rituximab, clinical practice often involves administering prednisone at doses of 50-100 mg before rituximab infusions to reduce infusion-related reactions, and using it as part of combination protocols for ongoing treatment regimens. The combination of prednisone and rituximab works synergistically, with prednisone managing symptoms and inflammation, and rituximab targeting the underlying disease process by depleting CD20-positive B cells, as noted in the context of treating conditions like lymphoma and autoimmune diseases 1.
From the Research
Combination of Prednisone and Rituximab
- The use of prednisone with rituximab has been studied in various contexts, including rheumatoid arthritis and pemphigus 2, 3.
- In patients with rheumatoid arthritis, oral prednisone has been used as a pretreatment to rituximab to prevent acute infusion reactions (AIRs) 2.
- A study found that 40 mg of oral prednisone given 1/2 hour prior to rituximab infusion reduced the incidence of AIRs, with 28% of subjects experiencing AIRs within 24 hours of their first infusion 2.
- In the treatment of pemphigus, first-line use of rituximab combined with short-term prednisone was found to be more effective than prednisone alone, with fewer adverse events 3.
Safety and Efficacy
- The combination of prednisone and rituximab has been shown to be effective in achieving complete remission in patients with systemic rheumatoid vasculitis (SRV) 4.
- However, rituximab therapy has also been associated with an increased risk of infectious complications, particularly in patients with hematological malignancies 5.
- Monitoring of absolute neutrophil count and immunoglobulin levels, as well as identification of high-risk groups for infectious complications, is recommended when using rituximab 5.
Mechanism of Action
- Rituximab has been found to induce substantial T cell depletion, mainly of CD4+ cells, which is associated with clinical response in rheumatoid arthritis 6.
- The mechanism of action of rituximab may depend at least in part on T cells, and routine monitoring of T cells may be useful in the clinical setting of rheumatoid arthritis 6.