Take both Nplate and Rituximab at the same time

[farasad2001]

I have ITP and Anticardiolipin

Antibody. I took my first injection of Rituximab two days ago. Even my Platelet count fell to 1000 after injection but doctors still want to keep me on treatment with rituximab. And also they want to start the Nplate for me today . I've asked doctors if it's a good idea to be on both medications (Nplate and Rituximab) at the same time. They said there is no issue but their answer couldn't convince me.

Does someone have information about both of these medications and know if it's ok to take both Nplate and Rituximab at the same time?

[rjsmyth]

They are two different approaches to the same issue - low count. Rituximab can be a long term help if your ITP is of a certain type. NPlate stimulates production of pre cursors to platelets in your bone marrow x-y=z where X is the extra platelets the NPlate encouraged y is your over active immune system and z is your resultant platelet count. I have had all treatments known for ITP including Rituximab (did nothing) and NPlate has kept my count in the safe zone (above 50) for the last four years. I would be much more confident of NPlate working rather than any other treatments. One thing to bear in mind that withdrawing from NPlate can cause your count to drop below what it was prior to the start of treatment. Good luck.

[bruiser2017]

Hi farasad, these are two very different treatments for ITP - low platelets counts.

Rituximab is a chemotherapy drug that targets the CD20 auto-immune B-lymphocytes; the effect is to stop the markers attached to platelets that tell the spleen to destroy the platelets.

Standard Rituximab regime for ITP patients is 4 intravenous infusions spread over 4 weeks; the infusions normally take between 5 - 7 hours each time and normally there would be a pre infusion of liquid paracetamol + prednisolone.

It can take up to 6 weeks following the final infusion for the full effects on platelet levels to be seen, thus highly unlikely that you would see a rise in platelet numbers after just 1 dose.

I underwent Rituximab treatment back in April 2017 and I had 19 months of consistent counts of 150 - 225 (x 1000) then came back down with a bump. General theory is that Ritux provides remission for anywhere between 6 months and 4 years; I understand that the course can be repeated maybe 1 or 2 times following failure.

I started Romiplostim (Nplate) in February this year and am having some success although platelet counts and rise/fall times currently are very unpredictable. Nplate (Romiplostin) is a drug that stimulates the bone marrow to produce more platelets - more platelets that if marked for destruction - will be destroyed. I am no medical clinician but if I were you I would be asking very serious questions of your doctor as it seems illogical to run these two treatments at the same time; both Rituximab and Romiplostim (Nplate) are very expensive drugs/treatments.

Please let me know how you get on.

[Dahle2424 in reply to bruiser2017]

Hi Bruiser, - I need open heart surgery. 3 way by-pass. My "normal" everyday count is 5K.

That has been for over 30yrs. In need over 100K for the operation. Will Nplate work in the short run??

[bruiser2017 in reply to Dahle2424]

Hi Dahle2424, sorry to hear that you need a triple bypass. I can't advise on what will work for you, that has to be a decision by your haematologist. I can say that my recent experience with Nplate (Romiplostim) is that 4 weeks ago count was 24k and 2 weeks later 623k! I am on a minimum dose of 75mcg administered when my count drops below intervention level set by my haemo.

Nplate works quickly for me, but is not consistent in how long the effect lasts; there is a lead in time before the first dose will start to act, but again that is something for your haematologist and cardiac team to monitor. Hope this is some help

Good luck with your bypass, let us know how you get on.

All best for Christmas and the New Year.

[Fiddlersas]

I can’t answer your question but I can tell you that NPlate took nearly a year to start making much difference to me, then my platelets went wild for a while until they got the dose right. I’ve been medicine free for 2 years now with normal platelets.

Good luck!

[RINochka]

My doctor tell me it's a problem between nplate and Antiphospolipid syndrom.rituximab kicks in after 1 month and stays for almost 8 month. If you treatment not effectively it's new medication Tavalisse