A biologic medication that targets B cells, used for NMO, myasthenia gravis, and other autoimmune conditions.
Drug Class: biologic
Rituximab (Rituxan) is a monoclonal antibody that depletes B cells (a type of immune cell). It's used for severe autoimmune conditions including NMO and myasthenia gravis.
Key Takeaways
- Depletes B cells (immune cells)
- First-line for NMO
- IV infusion every 6 months typically
- Significant immunosuppression
- Infusion reactions possible
Common Uses
- Neuromyelitis optica (NMO)—first-line
- MOGAD
- Refractory myasthenia gravis
- Refractory thyroid eye disease
How It Works
- Targets CD20 protein on B cells
- B cells are destroyed
- Reduces antibody production
- Effects last months after infusion
Administration
- IV infusion over several hours
- Premedication (steroids, antihistamines)
- Initial: two infusions 2 weeks apart
- Then every 6 months typically
- Done in infusion center
Side Effects
Infusion Reactions
- Fever, chills
- Rash
- Low blood pressure
- Usually manageable with premedication
Infection Risk
- Increased susceptibility
- Screen for hepatitis B before
- Avoid live vaccines
- Report fever/illness promptly
Less Common
- Low immunoglobulin levels
- Late neutropenia
- PML (extremely rare)
Before Starting
- Hepatitis B screening
- Immunization update (before starting)
- Baseline immunoglobulin levels
- TB screening
Monitoring
- B cell counts (CD19/CD20)
- Immunoglobulin levels
- Signs of infection
- Response to treatment
How Long to Treat
- Long-term for relapsing conditions
- Duration individualized
- May continue years in NMO
- Stopping risks relapse
Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice.
Medically Reviewed Content
This article meets our editorial standards
- Written by:
- Hashemi Eye Care Medical Team
- Medically reviewed by:
- Board-Certified Neuro-Ophthalmologist (MD, Neuro-Ophthalmology)
- Last reviewed:
- January 30, 2025