Switching from from N Plate to Rituxan

My 80 yr old mother has had ITP diagnosed for about 8 years, with platelet levels dropping below 10K. Treatment with Prednisone and WinRho were either ineffective or produced adverse reactions. She went on N Plate about 2 years ago and stabilized her platelet count between 75-100K, great!

She has been experiencing serious joint problems lately which limit her mobility. Her doctor is looking to switch her to Rituxan because of this and bone marrow issues? She has had arthritis problems in the past.

Has anyone made this treatment switch, any comments and advice? I'm afraid her platelet count count will drop quickly when getting off N Plate, despite one treatment ending and the other starting the same week.

Thanks for any advice!

Rituxan usually takes 4-12 weeks to kick in, and it doesn't work for everybody - so you are right, stopping nPlate and starting Rituxan doesn't sound like the best plan. Could she stay on nPlate until you see if the Rituxan is working?
Erica

Yeah, that combination will be a tough transition. How well does she respond to Prednisone? Maybe a low dose in between would be the trick. I'd definitely talk to her doctor about it. Maybe he's planning to continue N-Plate until Rituxan kicks in.

I had Nplate and Rituxan at the same time. Started on NPlate but wasn't liking the side effects so we started Rituxan. The first round of Rituxan lasted about 7 months. It was nice not to have to go get a shot once a week! Good for your mom being able to handle the NPlate for so long! Let us know what you decide.

Am getting my first Rituxan infusion tomorrow. Any tips on what to expect? Dr says will take about 8 hours - can anyone share their first experience w/me? Getting nervous about this. txs to all

Rituxan didn't work for me, but I'm glad I got to try it. I had 4 infusions, and none lasted anywhere near 8 hours--maybe all four together lasted 8 hours--is that what your doctor means? I'm sure different institutions handle the infusions differently. My first infusion took longer than the others, and I seem to recall it took 2 or 3 hours. I was given an antihistamine first, which made me sleepy. I had my choice of being in a group room or a private room, and I thought I could read so I opted for the private room. I had water and, I think, I could have snacks too. I was too sleepy to read anything heavy. I watched tennis on a tiny television set and had a hard time staying very alert for that too. By the time it was over, I was alert enough to drive myself safely home.

I had no bad side effects. (Turns out I had no good side effects either!)

One humbling thing: In the bigger room next door, I could hear some cancer patients being infused with much stronger treatments, and their occasional moans and cries made me feel fortunate to have ITP instead of something worse.

Karen - you did have fast infusions compared to most. My first infusion was 6 1/2 hours. The other three took about five hours. I think the first hour was the Benedryl IV.

Thank you for all the replies!

Some additional info- Mom tried Prednisone but it was not effective. She had a bad reaction to WinRho- severe chills and then a very mild heart attack.

I am talking with the doctor tonite so I will clarify the overlap period for the drugs, but it sounds like she will be on both for months from the replies here.

So I am just questioning whether she needs to get off N-Plate which has been so effective; and as far as I know she has only a 50% chance of Rituxan working. As I said, the switch is to alleviate joint pain in the legs and possible bone marrow issues. But we can't be sure the joint pain is from N-Plate and I'm not clear on the risks of bone marrow scarring with N-Plate. Anyone know the risk and time for scarring to become a problem. She's not a kid, so issues 10 yrs down the road aren't significant when compared to the benefit of N-Plate.

Thanks!

she doesn't have to be on both for a long time. you can stop NPlate with no taper, but it may cause a drastic drop in her counts. Extended use of NPlate can cause problems with bone marrow, pretty serious stuff too. And the joint pain, I can attest to. It was terrible for me. Wouldn't go back to NPlate.

Rituxan has a pretty good success rate. Most people tolerate it well. It's usually only 4 infusions; any more than that might be overkill. I hope the transition goes well.

Sandi, maybe my short infusion times were connected to the treatment not working for me.

I don't know, Karen. I tend to think not, because they are saying now that the standard dose given to most people is not needed for ITP and that lower doses or less infusions can be just as effective. I was a big dummy and never asked what dose I had...it was a long time ago and it didn't occur to me. I don't have anything to compare it to. Maybe they just gave it to you faster. I remember my one nurse telling me a year after I had mine that they were giving it to people much faster - I didn't believe her because I know the importance they place on slow infusions. Maybe there is a trick that a few places are using.

My first infusion was only 3 hours and the three doses after were 1.5 hours. I had no problems with that speed. I was a little concerned at first.

Is the 4 to 6 weeks usual for Rituxan to bring counts above 15th? Any idea why it takes that long?
Thanks,
Bernadette

Rituxan targets B cells and T cells, which are a type of white cell that produces the antibodies that destroy platelets. It takes time to wipe those out enough to make a difference in platelet counts.