From the Guidelines
Rituximab (Rituxan) can be used in patients with a history of Herpes Simplex Virus (HSV) infection, but antiviral prophylaxis should be considered in selected subjects with a history of recurrent HSV reactivations or additional risk factors. When using rituximab in patients with a history of HSV, it is essential to weigh the benefits of treatment against the potential risks of HSV reactivation. According to the most recent guidelines, antiviral prophylaxis may be considered in patients with a history of recurrent HSV reactivations or additional risk factors, such as concomitant treatment with high-dose steroids or rituximab 1.
Key Considerations
- Patients with a history of HSV who receive rituximab should be closely monitored for signs of HSV reactivation, such as oral or genital lesions.
- Antiviral prophylaxis, such as acyclovir or valacyclovir, may be prescribed for the duration of rituximab therapy and for 6-12 months afterward to reduce the risk of HSV reactivation.
- The immunosuppressive effects of rituximab can last for several months after treatment completion, which is why extended antiviral prophylaxis is important.
- Clinicians should be aware of the clinical spectrum of HSV reactivations in patients with compromised immune systems, especially disseminated infections in heavily pre-treated patients 1.
Recommendations
- Antiviral prophylaxis should be considered in patients with a history of recurrent HSV reactivations or additional risk factors, such as concomitant treatment with high-dose steroids or rituximab.
- Patients should be educated on the signs and symptoms of HSV reactivation and instructed to report any suspicious lesions promptly.
- Regular monitoring of patients with a history of HSV is crucial to promptly identify and manage any potential reactivations. The most recent study 1 provides guidance on the prevention and management of infectious complications in patients with chronic lymphocytic leukemia (CLL) treated with BTK and BCL-2 inhibitors, which is relevant to the use of rituximab in patients with a history of HSV.
From the FDA Drug Label
Infections have been reported in some patients with prolonged hypogammaglobulinemia (defined as hypogammaglobulinemia greater than 11 months after rituximab exposure) New or reactivated viral infections included cytomegalovirus, herpes simplex virus, parvovirus B19, varicella zoster virus, West Nile virus, and hepatitis B and C. RITUXAN is not recommended for use in patients with severe, active infections. have or have had any severe infections including: ... Herpes simplex virus (HSV)
Rituxan can be used in patients with a history of Herpes Simplex Virus (HSV) infection, but it is not recommended for use in patients with severe, active infections. Patients with a history of HSV should be monitored for reactivation of the virus during and after treatment with Rituxan 2.
From the Research
Rituxan (Rituximab) and Herpes Simplex Virus (HSV) Infection
- There is no direct evidence in the provided studies that specifically addresses the use of Rituxan (rituximab) in patients with a history of Herpes Simplex Virus (HSV) infection.
- However, studies have shown that immunosuppressive therapies, including rituximab, can increase the risk of viral reactivation, such as hepatitis B virus (HBV) reactivation 3, 4.
- The use of antiviral prophylaxis is recommended in patients with a history of viral infections, such as HBV, who are undergoing immunosuppressive therapy 3, 4.
- Acyclovir prophylaxis has been shown to be effective in preventing HSV reactivation in immunocompromised patients 5, 6.
- Famciclovir prophylaxis has also been shown to be effective in preventing HSV reactivation in patients undergoing laser resurfacing procedures 7.
- It is essential to note that the provided studies do not directly address the use of rituximab in patients with a history of HSV infection, and therefore, no conclusive evidence can be drawn from these studies.