From the Guidelines
Rituximab can occasionally cause vision changes as a side effect, though these are relatively uncommon, and patients should contact their healthcare provider immediately if they experience any vision changes while on rituximab therapy. Patients may experience blurred vision, double vision, or changes in visual acuity. More serious ocular complications can include uveitis, optic neuritis, or retinal changes. Some vision changes may be related to rituximab's mechanism as a B-cell depleting monoclonal antibody, which can affect immune function and potentially lead to inflammatory processes in ocular tissues. In rare cases, vision changes might be associated with progressive multifocal leukoencephalopathy (PML), a serious neurological complication of rituximab 1.
Key Points to Consider
- Vision changes are relatively uncommon side effects of rituximab
- Patients should immediately report any vision changes to their healthcare provider
- Serious ocular complications can occur, including uveitis, optic neuritis, or retinal changes
- Rituximab's mechanism as a B-cell depleting monoclonal antibody may contribute to vision changes
- Rare but serious complications like PML can be associated with vision changes
Recommendations for Management
- Patients on rituximab therapy should be monitored for vision changes
- Healthcare providers should perform an eye examination, neurological assessment, or imaging studies to determine the cause of vision changes if they occur
- Depending on the severity and nature of the visual symptoms, the treatment plan may need to be adjusted, including potentially discontinuing rituximab if the side effects are significant 1.
Important Considerations
- The safety profile of rituximab has been evaluated in various studies, including those in patients with rheumatoid arthritis and chronic lymphocytic leukemia 1
- Rituximab desensitization is safe and successful and can be completed within 1 day, but should be performed under the guidance of experienced staff who can manage allergic reactions 1
From the Research
Rituximab Vision Changes
- Rituximab has been studied for its effects on vision in patients with autoimmune retinopathy (AIR) and non-infectious uveitis and scleritis 2, 3.
- In a study of 16 AIR patients treated with rituximab, the rate of visual decline was significantly less after rituximab initiation compared to the rate of visual decline prior to rituximab initiation (P = .005) 2.
- Seventy-seven percent of eyes had stable or improved visual acuity 6 months after rituximab initiation 2.
- In a review of literature on rituximab use for non-infectious uveitis and scleritis, rituximab was found to be effective in treating these conditions, with a positive therapeutic response in 83.5% of patients with non-infectious uveitis and 93.3% of patients with scleritis 3.
- No significant changes in cone densities were found in six eyes with serial adaptive optics scanning laser ophthalmoscopy (AO-SLO) imaging after rituximab treatment 2.
- The most common adverse events associated with rituximab treatment were infusion reactions of various severity 3.
Mechanism of Action
- Rituximab is a monoclonal antibody that targets CD20-positive B cells, leading to their depletion 4, 5.
- The mechanism of action of rituximab in treating autoimmune diseases is thought to be related to its ability to deplete B cells, which play a key role in the immune response 4, 5.
- However, the exact mechanism of action of rituximab in treating non-infectious uveitis and scleritis is not fully understood and may involve multiple factors, including the reduction of inflammatory cytokines and the modulation of the immune response 3.
Comparison with Other Treatments
- Rituximab has been compared to other treatments, such as abatacept and tocilizumab, in patients with rheumatoid arthritis and inadequate response to TNF inhibitors 6.
- A prospective cohort study found that rituximab and tocilizumab were associated with greater improvements in outcomes at two years compared to abatacept 6.
- However, the choice of treatment depends on various factors, including the patient's medical history, the severity of the disease, and the presence of comorbidities 5.