Cytoxan or Rituximab?
I know this question may seem redudant to many of you, but if I have to move from methotrexate to a stronger drug, what are the major pros and cons of cytoxan vs rituximab? (Based on your experiences or advice given you by a specialist) I am obviously going to have to discuss this when I see a specialist, but in the event I need a stronger drug, I would like to know some of your opinions. Also, can you still work while taking cytoxan or rituximab? I work in a hospital (am in clinical rotations at the moment), and I wonder if I can continue to do that over the next 10 months if I have to switch to a stronger drug??? I'm sure there are many of you who have personal experience with one or both of these drugs. As always, thanks for sharing your wealth of knowledge!!!
From what I understand they have roughly the same success rate. I believe RTX is less toxic overall, and is more tolerable to most folks. But RTX is significantly more expensive as well.
I took CTX and it beats you down pretty good. It took me a while to figure out that I just had to take things really slow with it, including taking afternoon naps (so I was working part days at work and half at home after the nap). Thankfully my employer was very flexible on this, and my line of work is easily done from home as well. The other thing with CTX is you will get odd things that might seem like symptoms of the disease, but are actually reactions to the drug. In my case I had a lot of issues with pain in and around my eyes, that apparently was from the combination of Pred and CTX. Though I also think everyone's reactions are pretty unique to themselves.
Agree with everything said. The normal protocol is to use ctx unless problems are encountered. I worked while I was on it, but always tolerated drugs well. It is not the same for everyone.
My Rheumy also says that Rituxan and Cytoxan are about the same as far as how they treat WG, but Cytoxan has a longer track record. I take Cytoxan and work full time. I'm an Administrative Assistant, so I'm at a desk most of the time, not on my feet all day, but I haven't had too bad a time working. Occasionally, I will take a nap on my lunch hour, but for the most part I can get through the week. I do feel more run down and tired than usual, and sometimes get an upset stomach, but for the most part, I think I tolerate Cytoxan pretty well also.
Cytoxan was toxic to my bone marrow so I just got sicker and weaker while on it (two times). I can't take it again because it was so dangerous for me.
When I do rtx I get extremely weak for 6 weeks. Just standing has my legs shaking and I'm barely able to function. I'm not very strong otherwise due to Wegs and complications, so further weakening is really an issue. But rtx works great--gets me into remission-- and it's "only" a matter of toughing it out for 6 weeks. We are trying to do it annually, even though I felt the Wegs waking up about 8 months after the last round.
I've had both, first the Cytoxan for a year to which I didn't repond and now I'm taking Rituxan for the second time in almost 3 years which helped put the WG in remission - for a while anyway. The difference between the two is that Cytoxan is a chemotheorpy drug that works by stopping or slowing cell growth - which is pretty much your whole immune system. Rituxan is a biologic drug that specifically destroys the B cells which are the ones that cause all these issues with WG. Being on chemo, I was way more tired and this drug just did nothing for me so I was still constantly sick with the WG, taking the Rituxan was a piece of cake, just a few days of fatigue and feeling quite weak, but no hair loss or sickness! Make sure you ask your specialist about what the difference is between having Cytoxan infusions or taking it orally - I took both being told that since I wasn't responding to the infusions, the oral every day was a stronger doseage. Rituxan is only by infusion and you still take Methotrexate as usual.
My doctor started me on Cytoxan because in Alberta Canada it's free and has the most historical effectiveness, the Rituxan costs $10,000 CAD and not all insurance companies cover for it - thankfully mine did and this drug just hasn't been around for as long as the chemo.
I work in an office so and I've always worked fulltime, but once sick with WG being on the chemo, I only worked parttime just for a few months until I felt a little better (probably from being on the Prednisone!). Being in a hospital setting, you would have to protect yourself from all those infectious diseases that live there, but I think living with WG and having been on immune supressants, I've become a complete snob and am very careful of sick people and sick places!
Thanks to all of you for sharing your experiences with these drugs. I undoubtedly will end up being on one of them, so it is so nice to hear that others have been able to achieve remission with one and/or both. Also good to hear that many of you were able to continue working. That is very important to me, as I'm sure it was for you. Ultimately health is the top priority, however. I have 3 kids that I would like to be around to enjoy for a very long time. It makes me a little sad that so many of you have had to be on these drugs multiple times..... Dastardly disease!!!
Not necessarily. I'm not on any other immune-suppressant med in between rtx infusions. I'm pretty sure the RAVE trial didn't transition from rtx to mtx or imuran. It was rtx only.
Originally Posted by gurinbasra