obinutuzumab at a glance
Medicine class
Humanised anti-CD20 monoclonal antibody
Licensed uses
Selected cases of chronic lymphocytic leukaemia, follicular lymphoma and active lupus nephritis
Administration
Given by controlled intravenous infusion in a hospital or clinic
Important checks
Infection status, hepatitis B screening, blood counts and infusion-reaction risk
What is obinutuzumab used for?
UK-licensed uses include:
Previously untreated chronic lymphocytic leukaemia in adults with comorbidities making full-dose fludarabine-based therapy unsuitable, used with chlorambucil.
Previously untreated advanced follicular lymphoma, used with chemotherapy and potentially followed by maintenance treatment.
Follicular lymphoma that did not respond to, or progressed during or shortly after, rituximab-containing treatment, used with bendamustine and potentially followed by maintenance treatment.
Active Class III or IV lupus nephritis, with or without Class V disease, in adults, used with mycophenolate mofetil.
NHS England commissions elective obinutuzumab for some adults at risk of immune thrombotic thrombocytopenic purpura relapse who are refractory or intolerant to rituximab, subject to policy criteria.
How does obinutuzumab work?
Obinutuzumab binds to CD20, a protein on mature B lymphocytes. This promotes direct B-cell death and recruits immune cells to remove them. Depleting malignant B cells treats CLL and follicular lymphoma, while reducing harmful immune B-cell activity can help control lupus nephritis.
obinutuzumab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 1000 mg
How to take obinutuzumab
Obinutuzumab is not taken by mouth. A healthcare professional dilutes the concentrate and gives it through a dedicated intravenous line where monitoring and resuscitation facilities are available.
Medicines and fluids may be given beforehand to reduce infusion reactions or tumour lysis syndrome.
Tell the nurse immediately if symptoms develop during the infusion; it may need to be slowed or stopped.
Follow the treatment unit's instructions about blood-pressure medicines rather than withholding them yourself.
Food does not affect administration because obinutuzumab is given intravenously.
obinutuzumab side effects
Common or expected effects
- Infusion-related symptoms such as nausea, fever, chills, headache, tiredness, dizziness or changes in blood pressure
- Infections, including respiratory or urinary infections and shingles
- Reduced neutrophils, platelets or red blood cells
- Tiredness or weakness
- Diarrhoea or constipation
- Muscle, joint, back or limb pain
- Itching, skin changes or hair thinning
Get urgent medical advice
- Severe infusion reaction or anaphylaxis: breathing difficulty, wheeze, throat swelling, faintness or chest symptoms
- Serious infection or febrile neutropenia: fever, chills, cough, sore throat, urinary burning or marked illness
- Tumour lysis syndrome, which can cause dangerous blood-chemistry changes and kidney problems
- Severe thrombocytopenia, unusual bleeding or widespread bruising
- Hepatitis B reactivation
- New neurological symptoms suggesting progressive multifocal leukoencephalopathy
- Worsening cardiac problems, including abnormal rhythm, angina or heart failure
obinutuzumab in pregnancy
Human pregnancy data are limited, and obinutuzumab can cross the placenta and may deplete the baby's B cells. It should generally be avoided unless the specialist considers that the potential benefit outweighs the risk. Effective contraception is advised during treatment and for 18 months afterwards; inform the specialist promptly about pregnancy or plans to conceive. Babies exposed during pregnancy may need B-cell monitoring before live vaccines.
obinutuzumab while breastfeeding
Breastfeeding is not advised during obinutuzumab treatment or for 18 months after the last treatment because transfer into milk and harm to the infant cannot be excluded. Discuss feeding plans with the specialist team before treatment or delivery.
obinutuzumab interactions
Formal interaction studies are limited, so the clinical team should review prescribed, over-the-counter and herbal products.
Live viral vaccines
Avoid during treatment and until B-cell recovery because obinutuzumab suppresses B cells and vaccine safety or effectiveness may be reduced.
Antihypertensive medicines
Blood pressure can fall during infusion, so the treating team may temporarily alter their use after assessing the risk of hypertension.
Anticoagulants and platelet inhibitors
These may worsen bleeding if obinutuzumab causes thrombocytopenia, requiring individual review and closer monitoring.
Common questions about obinutuzumab
Answers are fully visible for fast scanning and source review.
Is obinutuzumab chemotherapy?
No. Obinutuzumab is a targeted monoclonal antibody against CD20, although it may be combined with chemotherapy or other immunosuppressive treatment.
Why is obinutuzumab given in hospital?
Infusion reactions can occur and occasionally become severe, so it is given where trained staff can monitor the patient, alter the infusion and provide emergency treatment.
What checks are needed before obinutuzumab?
Checks commonly include blood counts, kidney function, infection assessment, hepatitis B screening, current medicines and the risk of infusion reactions or tumour lysis syndrome.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.