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Rituximab RA Protocol — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyRituximab RA ProtocolSCE Rheumatology

A 50-year-old woman with RA has been treated sequentially with Methotrexate Adalimumab and then Tocilizumab all with inadequate response. Her rheumatologist considers Rituximab. What is the mechanism and dosing protocol for Rituximab in RA?

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Correct answer: C — Rituximab is an anti-CD20 monoclonal antibody causing B-cell depletion; standard RA dosing is two 1 g IV infusions 2 weeks apart with retreatment at minimum 6-monthly intervals guided by clinical response

Rituximab is a chimeric anti-CD20 monoclonal antibody that depletes CD20-positive B cells through complement-dependent cytotoxicity antibody-dependent cellular cytotoxicity and direct apoptosis induction. In RA the standard protocol is two 1 g IV infusions given 2 weeks apart. Retreatment is guided by clinical response typically at 6-12 monthly intervals. Each infusion requires premedication with IV Methylprednisolone (100 mg) Paracetamol and antihistamine to reduce infusion reactions. NICE recommends Rituximab specifically after inadequate response to at least one TNF inhibitor (though EULAR 2022 allows its use after any biologic failure). It is particularly effective in seropositive (RF+/anti-CCP+) RA.

Reference: NICE TA195 Rituximab; BSR 2019 biologic safety guidelines