From the Guidelines
Rituximab for Interstitial Lung Disease (ILD) should be administered at a dose of 1 g IV every 2 weeks for 2 doses, which may be repeated every 24 weeks as needed. This recommendation is based on the most recent and highest quality study available, which is the 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) guideline for the treatment of interstitial lung disease in people with systemic autoimmune rheumatic diseases 1.
Key Considerations
- The dosing regimen is specified in the guideline as 1 g IV every 2 weeks for 2 doses, with the option to repeat every 24 weeks as needed.
- It is essential to monitor patients for potential adverse effects, including cytopenias, infection, hepatitis B reactivation, and infusion reactions.
- Hepatitis B virus infection, hepatitis C virus infection, and latent TB screening should be performed before initiation of rituximab therapy.
- Regular monitoring of complete blood cell count (CBC) with differential at baseline and at 2- to 4-month intervals is also recommended.
Treatment Context
- Rituximab is conditionally recommended as a treatment option for people with SARD-ILD progression despite first ILD treatment, particularly for those with autoimmune features.
- The decision to use rituximab should be made by specialists experienced in ILD management, as it is often used off-label for this indication.
- Treatment should be administered in a setting equipped to manage potential infusion reactions, which commonly occur during the first infusion.
Patient Monitoring
- Regular monitoring of lung function, symptoms, and potential adverse effects is essential throughout treatment.
- Patients should be closely monitored for signs of infection, cytopenias, and other potential adverse effects of rituximab therapy.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Dosage of Rituxan (Rituximab) for Interstitial Lung Disease (ILD)
- The dosage of Rituxan (Rituximab) for Interstitial Lung Disease (ILD) is 1000 mg, administered on day 1 and day 15, in addition to mycophenolate mofetil (2 g daily) for 6 months 2.
- This dosage is based on a randomised, double-blind, two-parallel group, placebo-controlled trial that evaluated the efficacy and safety of rituximab in patients with connective tissue disease-associated ILD or idiopathic interstitial pneumonia.
- Other studies have also used similar dosages of rituximab, ranging from 1000 mg to 2000 mg, administered at varying intervals, to treat ILD in patients with connective tissue diseases 3, 4, 5, 6.
Administration and Combination Therapy
- Rituximab is often administered in combination with other immunosuppressive agents, such as mycophenolate mofetil, to treat ILD 2, 5.
- The combination of rituximab and mycophenolate mofetil has been shown to be effective in stabilizing lung function and improving outcomes in patients with ILD 2, 5.
Safety and Efficacy
- The safety and efficacy of rituximab in treating ILD have been evaluated in several studies, with varying results 3, 4, 5, 6.
- While some studies have reported significant improvements in lung function and quality of life, others have noted variable responses to treatment and potential adverse events, such as infections and respiratory complications 3, 4, 5, 6.