Corporate Medical Policy
Rituximab for the Treatment of Rheumatoid Arthritis
Description of Procedure or Service
Rituxan (rituximab) is genetically engineered chimeric mouse/human monoclonal antibody directed against
the DC20 antigen found on the surface of normal and malignant B lymphocytes. This monoclonal antibody
recognizes and sticks to the surface of white blood cells called B cells.These B cells produce the harmful
antibodies like the rheumatoid factors. After Rituxan (rituximab) labels the B cells, the body’s immune sys-
tem activates and kills the bad cells. These B cells return in about 1 month. Rituxan is given IV.
Rheumatoid arthritis is a chronic condition where the person’s own immune system causes inflammation
of the joints and the tissue around the joints. The body is equipped with a defense mechanism called the
immune system which protects you from disease and infection. When a person has an autoimmune condi-
tion, the immune system creates antibodies that attacks it’s own tissues by mistake. Rheumatoid arthritis
usually starts between the age of 25 and 55 and the cause is unknown. Symptoms of rheumatoid arthritis
(RA) are described as painful inflammation of the synovial tissue lining the joints. These patients have ele-
vated levels of tumor necrosis factor-alpha (TNF-a) in their joints. Chronic joint inflammation leads to tissue
break down, cell damage to the bone, edema, warmth, redness, joint stiffness, and pain. These patients are
also fatigued, weak, have a low-grade fever, and loss of appetite.
Tumor necrosis factor inhibiting drugs such as Remicade (infliximab), Enbrel (etanercept), or Humira (adal-
imumab) are considered first line treatment before considering the use of Rituxan (rituximab). Patients will
sometimes become intolerant or unresponsive to TNF inhibiting therapy and for these Rituxan (rituximab)
may be considered.