Rituximabe Administration in Patients with Recent Infection

Patient Selection and Pre-Treatment Evaluation

The American College of Rheumatology conditionally recommends adding conventional synthetic DMARDs instead of biologic or targeted synthetic DMARDs for patients with a history of severe infection in the last 12 months 1
Patients who have had a severe infection in the last 12 months should receive alternative treatment with conventional DMARDs instead of biologic therapy such as rituximabe 1
A 7-day period since active infection is insufficient to consider the safe use of rituximabe 1
Screening for hepatitis B (HBsAg, anti-HBc, anti-HBs) is mandatory before initiating rituximabe, as the risk of HBV reactivation is highest among all immunosuppressive agents 2
Antiviral prophylaxis is strongly recommended for all patients who are anti-HBc positive (regardless of HBsAg status) starting rituximabe 1, 2
Tuberculosis screening (interferon-gamma release assay or tuberculin skin test) should be performed 2
Baseline IgG level should be measured, as low IgG (<3 g/L) predicts a higher risk of secondary immunodeficiency 2

Consider prophylaxis for Pneumocystis jiroveci in all patients receiving rituximabe, especially those with concomitant immunosuppression 3