Tetanus and Rituximab

My son stepped on a steel glass at his grandmother's this weekend, the glass cut him under his toe. 
He did not tell me until yesterday.  It seems like the cut is quite deep, I have been cleaning it with
antiseptic and covering it with Poysporin. 

Andy,  should we be worried about tetanus because he has had rituximab treatment?  I am not sure if ivig provides protection against tetanus (his last ivig treatment was on Friday, Sept 19th).   

This boy sure keeps us busy, always something new with him!!

Thank you once again,
Sharmin

If he has had his tetanus vaccination, which I am sure he has had, there is no danger.

http://www.rituxan.com/ra/hcp/safety-admin/safety/index.m

In controlled RA clinical trials with Rituxan5:

No treatment-emergent tuberculosis has been observed
No hematologic malignancies (lymphomas) have been reported
Low incidence of opportunistic infections
Observed rate of malignancies was consistent with the rate observed in a similar RA population
Existing antibody titers against mumps, rubella, varicella, tetanus toxoid, influenza, and pneumococcus remained stable over 6 months

Keep it clean and show to the doctor if there is any sign of infection.

Thank you so much Andy. 
It is funny how he 'forgot' to tell me until he began to limp yesterday   

Sharmin

http://lib.bioinfo.pl/auid:5784

Ann Rheum Dis. 2008 Feb 4; : 18250115 (P,S,G,E,B,D) Variability in the biological response to anti-CD20 B-cell depletion in SLE.
 
[My paper] Daniel Albert, Jonathan Dunham, Sadia Khan, Janet Stansberry, Sharon Kolasinski, Donald Tsai, Sally Pullman-Mooar, Felicia Barnack, Christopher Striebich, R John Looney, Eline T Luning Prak, Robert Kimberly, Yawei Zhang, Robert Eisenberg
Dartmouth Medical School, United States.
OBJECTIVE: To study the effects in systemic lupus erythematosus (SLE) of B-cell directed therapy with rituximab, a chimeric monoclonal antibody directed at CD20+ B cells, without concomitant immunosuppressive therapy in mild to moderate SLE. METHODS: Patients (n=24) with active SLE and failure of >/=1 immunosuppressive were recruited from three university centers into this Phase I/II prospective open-label study. Patients were followed for one year to assess safety, efficacy, and biologic effects. RESULTS: Eighteen of the patients scheduled to receive the full lymphoma dose of rituximab were evaluable for B-cell levels in peripheral blood. Of these, 17 had effective CD19+ B-cell depletion (<5 per microL). However, 6 of the depleted patients showed B-cell return before 24 weeks. Seventy percent of patients improved by Week 55, as defined by an SLE Disease Activity Index (SLEDAI) score improvement of >/=2 units from baseline. The degree of CD19+ B-cell depletion was correlated with SLEDAI improvement at Week 15 (r=0*84). In general, rituximab infusions were well tolerated. Approximately one-third of the patients developed human anti-chimeric antibody (HACA) titers, which correlated with poor B-cell depletion. Most patients (9 of 14) did not respond to immunizations with Pneumovax and [bgcolor=#00ff44]tetanus toxoid[/bgcolor].
CONCLUSIONS: Rituximab is a promising new therapy for SLE. The variability of responses in SLE patients may be related to HACA formation. The failure to respond to immunizations is surprising, in view of the apparently low risk of infections. Better biologic markers are necessary to follow these patients during treatment.

Umair

Thank you for the information Umair,

Andy, does this mean that patients have protection from previous immunizations - but immunizations given during the rituximab therapy will not take?  My son's immunizations were up to date before the rituximab, so I am hoping that and the ivig is giving him protection. 

My son is also supposed to get a booster this year - that is typically given in 5th grade which includes the hep c vaccination.  His hematologist advised that he not get it this year because of the ritux and the ivig treatments because as Umair's post states he probably won't respond to it. 

I think I have to tie this kid up for a while so he doesn't keep doing crazy things and making me worry!!   

Thanks again,

Sharmin