Ruxience

Generic name: rituximab
Brand names: Riabni, Rituxan, Ruxience, Truxima
Drug class: CD20 monoclonal antibodies

Medically reviewed by A Ras MD.

What is Ruxience?

Ruxience is a prescription medicine used to treat adults with Non-Hodgkin’s Lymphoma (NHL): alone or with other chemotherapy medicines; Chronic Lymphocytic Leukemia (CLL): with the chemotherapy medicines fludarabine and cyclophosphamide; Granulomatosis with Polyangiitis (GPA) (Wegener’s Granulomatosis) and Microscopic Polyangiitis (MPA): with glucocorticoids, to treat GPA and MPA.

Ruxience is not indicated for treatment of children.

Description

Rituximab-pvvr is a genetically engineered chimeric murine/human monoclonal IgG1 kappa antibody directed against the CD20 antigen. Rituximab-pvvr has an approximate molecular weight of 145 kD.

Rituximab-pvvr is produced by mammalian cell (Chinese Hamster Ovary) suspension culture in a nutrient medium.

RUXIENCE (rituximab-pvvr) injection is a sterile, preservative-free, clear to slightly opalescent, colorless to pale brownish-yellow solution for intravenous infusion. RUXIENCE is supplied at a concentration of 10 mg/mL in either 100 mg/10 mL or 500 mg/50 mL single-dose vials. Each mL of solution contains 10 mg rituximab-pvvr, 0.056 mg of edetate disodium dihydrate, 1.2 mg of L-histidine, 2.57 mg of L-histidine hydrochloride monohydrate, 0.2 mg of polysorbate 80, 85 mg of sucrose, and Water for Injection, USP. The pH is 5.8.

Mechanism of Action

Rituximab-pvvr is a monoclonal antibody. Rituximab products target the CD20 antigen expressed on the surface of pre-B and mature B-lymphocytes. Upon binding to CD20, rituximab products mediate B-cell lysis. Possible mechanisms of cell lysis include complement dependent cytotoxicity (CDC) and antibody dependent cell mediated cytotoxicity (ADCC). B cells are believed to play a role in the pathogenesis of rheumatoid arthritis (RA) and associated chronic synovitis. In this setting, B cells may be acting at multiple sites in the autoimmune/inflammatory process, including through production of rheumatoid factor (RF) and other autoantibodies, antigen presentation, T-cell activation, and/or proinflammatory cytokine production.

What is the most important information I should know about Ruxience?

Ruxience can cause serious side effects that can lead to death, including:

Infusion-related reactions. Infusion-related reactions are very common side effects of Ruxience treatment. Serious infusion-related reactions can happen during your infusion or within 24 hours after your infusion of Ruxience. Your healthcare provider should give you medicines before your infusion of Ruxience to decrease your chance of having a severe infusion-related reaction.
Tell your healthcare provider or get medical help right away if you get any of these symptoms during or after an infusion of Ruxience:
- hives (red itchy welts) or rash
- itching
- swelling of your lips, tongue, throat or face
- sudden cough
- shortness of breath, difficulty breathing, or wheezing
- weakness
- dizziness or feel faint
- palpitations (feel like your heart is racing or fluttering)
- chest pain
Severe skin and mouth reactions. Tell your healthcare provider or get medical help right away if you get any of these symptoms at any time during your treatment with Ruxience:
- painful sores or ulcers on your skin, lips or in your mouth
- blisters
- peeling skin
- rash
- pustules
Hepatitis B virus (HBV) reactivation. Before you receive your Ruxience treatment, your healthcare provider will do blood tests to check for HBV infection. If you have had hepatitis B or are a carrier of hepatitis B virus, receiving Ruxience could cause the virus to become an active infection again. Hepatitis B reactivation may cause serious liver problems including liver failure, and death. You should not receive Ruxience if you have active hepatitis B liver disease. Your healthcare provider will monitor you for hepatitis B infection during and for several months after you stop receiving Ruxience.
Tell your healthcare provider right away if you get worsening tiredness, or yellowing of your skin or white part of your eyes, during treatment with Ruxience.
Progressive Multifocal Leukoencephalopathy (PML). PML is a rare, serious brain infection caused by a virus that can happen in people who receive Ruxience. People with weakened immune systems can get PML. PML can result in death or severe disability. There is no known treatment, prevention, or cure for PML.
Tell your healthcare provider right away if you have any new or worsening symptoms or if anyone close to you notices these symptoms:
- confusion
- dizziness or loss of balance
- difficulty walking or talking
- decreased strength or weakness on one side of your body
- vision problems

See “What are the possible side effects of Ruxience?” for more information about side effects.

What should I tell my healthcare provider before using Ruxience?

Before you receive Ruxience, tell your healthcare provider about all of your medical conditions, including if you:

have had a severe reaction to Ruxience or another rituximab product
have a history of heart problems, irregular heart beat or chest pain
have lung or kidney problems
have an infection or weakened immune system.
have or have had any severe infections including:
- Hepatitis B virus (HBV)
- Hepatitis C virus (HCV)
- Cytomegalovirus (CMV)
- Herpes simplex virus (HSV)
- Parvovirus B19
- Varicella zoster virus (chickenpox or shingles)
- West Nile Virus

have had a recent vaccination or are scheduled to receive vaccinations. You should not receive certain vaccines before or during treatment with Ruxience.
are pregnant or plan to become pregnant. Talk to your healthcare provider about the risks to your unborn baby if you receive Ruxience during pregnancy.
Females who are able to become pregnant should use effective birth control (contraception) during treatment with Ruxience and for at least 12 months after the last dose of Ruxience. Talk to your healthcare provider about effective birth control.
Tell your healthcare provider right away if you become pregnant or think that you are pregnant during treatment with Ruxience.
are breastfeeding or plan to breastfeed. It is not known if Ruxience passes into your breast milk. Do not breastfeed during treatment and for at least 6 months after your last dose of Ruxience.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you take or have taken:

a Tumor Necrosis Factor (TNF) inhibitor medicine
a Disease Modifying Anti-Rheumatic Drug (DMARD)

If you are not sure if your medicine is one listed above, ask your healthcare provider.

How should I use Ruxience?

Ruxience is given by infusion through a needle placed in a vein (intravenous infusion), in your arm. Talk to your healthcare provider about how you will receive Ruxience.
Your healthcare provider may prescribe medicines before each infusion of Ruxience to reduce infusion side effects such as fever and chills.
Your healthcare provider should do blood tests regularly to check for side effects to Ruxience.
Before each Ruxience treatment, your healthcare provider or nurse will ask you questions about your general health. Tell your healthcare provider or nurse about any new symptoms.

What are the possible side effects of Ruxience?

Ruxience can cause serious side effects, including:

See “What is the most important information I should know about Ruxience?”
Tumor Lysis Syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause you to have:
- kidney failure and the need for dialysis treatment
- abnormal heart rhythm
TLS can happen within 12 to 24 hours after an infusion of Ruxience. Your healthcare provider may do blood tests to check you for TLS. Your healthcare provider may give you medicine to help prevent TLS.
Tell your healthcare provider right away if you have any of the following signs or symptoms of TLS:
- nausea
- vomiting
- diarrhea
- lack of energy
Serious infections. Serious infections can happen during and after treatment with Ruxience, and can lead to death. Ruxience can increase your risk of getting infections and can lower the ability of your immune system to fight infections. Types of serious infections that can happen with Ruxience include bacterial, fungal, and viral infections. After receiving Ruxience, some people have developed low levels of certain antibodies in their blood for a long period of time (longer than 11 months). Some of these people with low antibody levels developed infections. People with serious infections should not receive Ruxience. Tell your healthcare provider right away if you have any symptoms of infection:
- fever
- cold symptoms, such as runny nose or sore throat that do not go away
- flu symptoms, such as cough, tiredness, and body aches
- earache or headache
- pain during urination
- cold sores in the mouth or throat
- cuts, scrapes or incisions that are red, warm, swollen or painful
Heart problems. Ruxience may cause chest pain, irregular heartbeats, and heart attack. Your healthcare provider may monitor your heart during and after treatment with Ruxience if you have symptoms of heart problems or have a history of heart problems. Tell your healthcare provider right away if you have chest pain or irregular heartbeats during treatment with Ruxience.
Kidney problems, especially if you are receiving Ruxience for NHL. Ruxience can cause severe kidney problems that lead to death. Your healthcare provider should do blood tests to check how well your kidneys are working.
Stomach and Serious bowel problems that can sometimes lead to death. Bowel problems, including blockage or tears in the bowel can happen if you receive Ruxience with chemotherapy medicines. Tell your healthcare provider right away if you have any severe stomach-area (abdomen) pain or repeated vomiting during treatment with Ruxience.

Your healthcare provider will stop treatment with Ruxience if you have severe, serious or life-threatening side effects.
The most common side effects of Ruxience include:

infusion-related reactions (see “What is the most important information I should know about Ruxience?”)
infections (may include fever, chills)
body aches
tiredness
nausea

In adult patients with GPA or MPA the most common side effects of Ruxience also include:

low white and red blood cells
swelling
diarrhea
muscle spasms

Other side effects with Ruxience include:

aching joints during or within hours of receiving an infusion
more frequent upper respiratory tract infection

These are not all of the possible side effects with Ruxience.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Ruxience

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or healthcare provider for information about Ruxience that is written for healthcare professionals.

What are the ingredients in Ruxience?

Active ingredient: rituximab-pvvr

Inactive ingredients: edetate disodium dihydrate, L-histidine, L-histidine hydrochloride monohydrate, polysorbate 80, sucrose, and Water for Injection, USP.