07-09-2006, 10:41 PM
:) I am trying to find out information on any of these meds. My sister has lupus and has been giving herself methotrexate injections for 2 1/2 years. Her doctor would like her to try Remicade, if not that then either Rituxan or Humira. She would still continue her methotrexate injections as well. They would like her to get started ASAP. She is quite scared and is planning on the Remicade, but she would like some feed back on it. She has no idea of what to expect from any of these medications and how they administer the remicade. If anyone has any information it would be greatly appreciated! :) Thank You! JayJayF
07-10-2006, 06:30 AM
Hi Jay Jay F. Remicade is given by IV and so is Rituxan. I have received Rituxan for my lupus/lupus nephritis. Rituxan is a biological agent that targets the B-cells. With Rituxan they generally give you Benadryl and Tylenol before the infusion to ward off any possible reactions. You can react to Rituxan by getting hives, throat swelling, difficulty breathing, joint/muscle pain. You are monitored closely and the infusion especially the first day can take up to 6 hours. Visit www.rituxan.com which is the offical website. when I received Rituxan I did not have any problems. I was given 50mg of Benadryl IV and Tylenol 650mg. I just recently treated a patient in the infusion clinic that I work and she did react to the rituxan by getting hives. But the infusion was not stopped by her rhematologist- she was given more benadryl IV and then she was also given a small dose of a pain medication (demerol) to help counteract the reaction. It worked and she was able to finish the infusion without difficulty.
Remicade is kind of similar to Rituxan but is not a biological agent and does not target B-cells . It is also given IV and your sister would more than likely receive Benadryl and Tylenol before the infusion. With remicade you can also have throat swelling, difficulty breathing , and hives. I treat alot of patients and 98% of the patients do fine with it. You can also visit www.remicade.com (the official website.). Just so that you know I have not seen remicade given for lupus but for rhematoid arthritis. In my opinion I would look into the rituxan before the remicade. But that is something she would need to discuss with her doctor to make the final decision.
Also be aware that both of these medication are immunosuppressants so you must be careful with infections. I hope that helps. I haven't had any experience with the humira, but it too is an immunosuppressant. you could check out their website too for more information. Good luck! :lol:
07-10-2006, 06:58 AM
Hi JayJay :lol:
Remicade (Infliximab) reduces the effects of a substance in the body that can cause inflammation. It is primarily used to treat rheumatoid arthritis, psoriatic arthritis, ulcerative colitis (Crohn's disease), and ankylosing spondylitis. Remicade is often used when other medicines have not been as effective as doctors would like.
The drug has been getting some bad press when used for Lupus because one of its side-effects is that it produces Lupus-like symptoms. Treatment with Remicade may increase your risk of developing certain types of cancer or autoimmune disorders (such as a lupus-like syndrome). Before your sister starts treatment with Remicade, she should make sure that her doctor performs tests to make sure that she does not have tuberculosis or other any other type of infection. Remicade can lower the blood cells that help your body fight infections. This can make it easier to bleed from an injury or get sick from being around others who are ill. To be sure her blood cells do not get too low while using Remicade, her blood will need to be tested on a regular basis.
Serious and sometimes fatal infections may occur during treatment with Remicade. She sould contact her doctor right away if she shows any signs of infection such as: fever, chills, sore throat, flu symptoms, easy bruising or bleeding, pale skin, or unusual weakness. ALSO, she should not receive a "live" vaccine while she is being treated with Remicade, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to her.
HOW TO TAKE REMICADE:
Remicade is generally given as an injection through a needle placed into a vein. Her doctor, nurse, or other healthcare provider will give her this injection. This medicine is usually given at intervals of 2 to 8 weeks. Remicade must be injected slowly, over about 2 hours. Her doctor may wish to observe her after the injection, to make sure the medicine has not caused any serious side effects. She may be given instructions on how to use the injections at home. SHE SHOULD NOT use this medicine at home if she does not fully understand how to give the injection and/or how to properly dispose of needles and other items used in giving the medicine. It will be very important that she does not miss any scheduled visits to her doctor. If her Remicade is stored at home, keep it in the refrigerator. Do not allow the medicine to freeze and do not use it beyond the expiration date.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Serious and sometimes fatal infections may occur during treatment with Remicade. Contact your doctor right away if you have signs of infection such as:
· fever, chills, sore throat, flu symptoms;
· easy bruising or bleeding, pale skin, unusual weakness;
Call your doctor at once if you have any of these other serious side effects:
· feeling short of breath, even with mild exertion;
· swelling of your ankles or feet;
· problems with vision;
· chest pain, joint pain, redness or discoloration of your face;
· numbness or tingling;
· weak feeling in your arms or legs; or
· nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Other less serious side effects are more likely to occur, such as:
· stuffy nose, sinus pain; or
· mild stomach pain.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
RITUXIN - A central feature of systemic lupus erythematosus (SLE) is the loss of B-cell tolerance. B cells are essential to the development of systemic lupus erythematosus (SLE). The chimeric monoclonal antibody rituximab depletes B cells by targeting the pan-B-cell surface marker CD20. Rituximab is a chimeric monoclonal antibody reagent consisting of human IgG1. Rituxin was used to treat a type of cancer and now appears to be very effective at treating lupus, with just one injection easing symptoms in several patients for a year or more. The results of a clinical trial involving 17 patients are in the August issue of Arthritis and Rheumatism.
The finding of that trial has its roots in a hypothesis put forth by the team of physicians at the University of Rochester Medical Center who did the study. They suspected that because lupus involves the same immune cells as lymphoma, a drug successful at treating lymphoma might also help lupus patients. So doctors tested the medication rituximab, approved in 1997 to treat lymphoma, in patients with Lupus (the chronic inflammatory disease where the immune system mistakenly attacks a person's own tissues).
The results bear out the hypothesis. Eleven of the 17 patients had a significant drop in immune cells known as B cells, and the health of those patients improved significantly, an improvement that was evident for the 12 months that the study lasted. Several were able to reduce or go off their traditional lupus medications.
"In most patients, their lupus improved significantly," says rheumatologist R. John Looney, M.D., who led the study. "Since lupus differs a great deal from person to person, the ways that patients improved varied. Some had less joint pain; some had fewer skin rashes. But everyone who had fewer B cells had significantly improved health.
Besides the drug's success in treating the disease, scientists noted the lack of significant side effects with rituximab. Some patients had a reaction to the infusion of the medicine, but in the study, it occurred far less often than it does with cancer patients taking the drug.
How IS RITUXIN TAKEN:
The recommended dosage of Rituxan is 375 mg/m˛ given as a slow IV infusion once weekly for 4 or 8 doses. Rituxan is supplied in single-use vials containing 100 mg or 500 mg of Rituximab in a sterile, preservative-free solution at a concentration of 10 mg/mL. IV pumps may be used. In-line filters may be used, but are not required.
RITUXAN SHOULD NOT BE ADMINISTERED AS AN IV PUSH OR BOLUS.
Rituxan should be administered only by slow intravenous infusion.
Premedication with acetaminophen and diphenhydramine will probably be given before each infusion.
Patients requiring close monitoring during first and all subsequent infusions include those with pre-existing cardiac and pulmonary conditions, those with prior clinically significant cardiopulmonary adverse events, and those with high numbers of circulating malignant cells with or without evidence of high tumor burden.
RITUXIN SIDE EFFECTS:
The common side effects of Rituxan were determined from patients treated in clinical studies. Most of the people in the studies received the standard Rituxan dose for 4 weeks; some received the standard dose for 8 weeks, and others received slightly higher single doses. Most side effects were mild to moderate, and most occurred during the first infusion.
The most common adverse events were mild to moderate reactions during the first Rituxan administration: fever (53%), shaking chills (33%), weakness (26%), nausea (23%), and headache (19%). Hair loss was never reported.
Most of the time, side effects with Rituxan are mild to moderate. Usually, they are easy to treat. In most cases, side effects occur in the first 30 minutes to 2 hours after the treatment is started, and usually they go away before it is finished. Side effects are less common after the first treatment.
HUMIRA: HUMIRA (adalimumab) is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor (TNF). HUMIRA is a medicine called a TNF blocker, that is a type of protein that blocks the action of a substance your body makes called TNF-alpha. TNF-alpha (tumor necrosis factor alpha) is made by your body’s immune system. People with Lupus, RA or PsA in your body can attack normal healthy body tissues and cause inflammation especially in the tissues in your bones, cartilage, and joints. HUMIRA helps reduce the signs and symptoms of pain and swollen joints and may help prevent further damage to your bones and joints, and may help improve your ability to perform daily activities. In addition, HUMIRA helps reduce the signs and symptoms of pain and swollen joints.
HOW TO TAKE HUMIRA:
You take HUMIRA by giving yourself an injection under the skin once every other week, or more frequently (every week) if your doctor tells you to. If you accidentally take more HUMIRA than you were told to take, you should call your doctor. Make sure you have been shown how to inject HUMIRA before you do it yourself. You can call your doctor or the HUMIRA Patient Resource Center at 1-800-4HUMIRA (448-6472) if you have any questions about giving yourself an injection. Someone you know can also help you with your injection. Remember to take this medicine just as your doctor has told you and do not miss any doses.
If you forget to take HUMIRA when you are supposed to, inject the next dose right away. Then, take your next dose when your next scheduled dose is due. This will put you back on schedule.
Like all medicines that affect your immune system, HUMIRA can cause serious side effects. The possible serious side effects include:
Serious infections: There have been rare cases where patients taking HUMIRA or other TNF-blocking agents have developed serious infections, including tuberculosis (TB) and infections caused by bacteria or fungi. Some patients have died when the bacteria that cause infections have spread throughout their body (sepsis).
Nervous system diseases: There have been rare cases of disorders that affect the nervous system of people taking HUMIRA or other TNF blockers. Signs that you could be experiencing a problem affecting your nervous system include: numbness or tingling, problems with your vision, weakness in your legs and dizziness.
Malignancies: There have been very rare cases of certain kinds of cancer in patients taking HUMIRA or other TNF blockers. People with more serious RA that have had the disease for a long time may have a higher than average risk of getting a kind of cancer that affects the lymph system, called lymphoma. If you take HUMIRA or other TNF blockers, your risk may increase.
Lupus-like symptoms: Some patients have developed lupus-like symptoms that got better after their treatment was stopped. If you have chest pains that do not go away, shortness of breath, joint pain or a rash on your cheeks or arms that is sensitive to the sun, call your doctor right away. Your doctor may decide to stop your treatment.
Blood Problems: In some patients the body may fail to produce enough of the blood cells that help your body fight infections or help you to stop bleeding. If you develop a fever that bleed very easily or look very pale, call your doctor right away. Your doctor may decide to stop treatment.
Heart Problems: You should tell your doctor if you have ever been treated for heart failure. If you have, your doctor may choose not to start you on HUMIRA, or may want to monitor you more closely. If you develop new or worsening problems like shortness of breath or swelling of your ankles or feet, you should call your doctor right away.
Allergic reactions: In rare cases, patients taking HUMIRA have had severe allergic reactions leading to difficulty breathing and low blood pressure, or shock. Allergic reactions can happen after your first dose or may not happen until after you have taken HUMIRA many times. If you develop a severe rash, swollen face or difficulty breathing while taking HUMIRA, call your doctor right away or seek emergency care immediately.
What are the other more common side effects with HUMIRA?
Many patients experience a reaction where the injection was given. These reactions are usually mild and include redness, rash, swelling, itching or bruising. Usually, the rash will go away within a few days. If the skin around the area where you injected HUMIRA still hurts or is swollen, try using a towel soaked with cold water on the injection site. If you have pain, redness or swelling around the injection site that doesn’t go away within a few days or gets respiratory infections (sinus infections), headache and nausea.
HUMIRA can block the damage that too much TNF-alpha can cause, and it can also lower your ability to fight infections. Taking HUMIRA can make you more prone to getting infections or make any infection you have worse.
I hope that I have been able to answer all of your questions!
Best of Luck to you and to your sister
Peace and Blessings
07-10-2006, 07:22 AM
Hi Butterfly :lol:
I guess you and I were posting responses at the same time (lol) - I did not mean to repeat you or step on your toes. Sorry about that :?
07-10-2006, 04:08 PM
Saysusie- No problem! We're all here for the same reason :lol:
07-10-2006, 08:53 PM
:o Thank you everyone for your responses! Her Lupus is out of control right now. Her white blood count is extremely high, and her joints are deteriorating at a rapid rate. That is why her doctor had suggested the remicade. She also has Mitro-valve prolapse which I think takes out her chances for the Rituxan, although I am just guessing. Under the list of people who should not use this medication irregular heart beat was one of them, so I'm guessing. SHe already has the skin disorders (rash,hives) and an extreme amount of pain and joint swelling. She also doesn't have any insurance and is paying out of pocket for any treatments or doctor visits. The Lupus Foundation is supposed to help with some of the fee for the infusion. Her doctor had suggested the Remicade for every 6 months or so. He had stated that the Remicade may help her to go into remission. SHe had been in remission a few years ago taking some medicine I am unsure of the name, however one of her old Doctors (at the Mayo Clinic) took her off of it because she was doing fine. Little did we know that if she had just continued on it her remission probably would have lasted. She is now in Houston, she just happened to find this rheumatologist. If anyone knows of a really good one please let me know. Thank you again for your responses...it means a GREAT deal to me! :D If you have any more info. please let me know. Thanks again! P.S. I am not up on all of the spellings for these big words, so please excuse my flubs. :wink:
07-14-2006, 12:42 PM
Do not worry about your spelling..none of us here are MDs :lol:
I am in California and so cannot help much with doctors in Houston. Hopefully, someone will have more information than I.
I wish you the very best
Peace and Blessings