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. Patients receiving rituximab have an increased risk of HSV reactivation due to the medication's B-cell depleting effects, which compromise the immune system 1. For prophylaxis, acyclovir or valacyclovir can be prescribed, and the decision to use prophylaxis should be based on individual patient risk factors, such as concomitant treatment with high-dose steroids or rituximab 1. Some key points to consider when using rituximab in patients with a history of HSV infection include:
- Monitoring for signs of HSV reactivation, such as oral or genital lesions
- Considering antiviral prophylaxis in patients with a history of recurrent HSV reactivations or additional risk factors
- Being aware of the clinical spectrum of HSV and VZV reactivations in patients with CLL, especially disseminated VZV infection in heavily pre-treated patients 1
- The adjuvanted recombinant zoster vaccine (RZV) is recommended as a preventive strategy to reduce the incidence and severity of VZV reactivations and to potentially reduce the need for prophylaxis 1. It is essential to weigh the benefits and risks of rituximab treatment in patients with a history of HSV infection and to consider individual patient factors when making treatment decisions 1.
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 antiviral prophylaxis can be effective in preventing HSV reactivation in certain situations, such as laser resurfacing procedures 3, 4.
- The use of antiviral prophylaxis, such as famciclovir, has been shown to reduce the risk of HSV reactivation in patients with a history of HSV infection 3, 4.
- Additionally, the development of new antiviral therapeutics is ongoing, with several new compounds in various phases of clinical trials 5.
- It is worth noting that rituximab, an anti-CD20 agent, has been associated with an increased risk of viral reactivation, including hepatitis B reactivation 6.
- Antiviral prophylaxis is recommended in certain situations, such as in patients with hematologic malignancy treated with rituximab, to prevent viral reactivation 6.