Azathioprine v Rituximab

[Whiskers64]

After having seen my Rheumy today & being told that not only do I have RA but also pulmonary Fibrosis, Bronchiectasis & Emphysema. Been offered two forms of drugs to choose either Azathioprine or Rituximab side effects with both it’s whether I go for pills or infusion anybody had dealings with these two would be a great help in me choosing which.

[Lolabridge]

Bad luck with the lung issues. My consultant chose to put me on Rituximab because I had lung problems too. I’ve not suffered any side effects I’m aware of and it’s been brilliant at controlling my RA. It’s delivered by infusion in hospital and is a strong immune suppressing medication which stays in your system for 6-9 months, so that’s a bit of a disadvantage with Covid around. I’ve no experience of the other drug you’ve been offered but hopefully someone who has will reply.

[Whiskers64 in reply to Lolabridge]

Thank you so much for replying it gives me a bit more of an insight

[Neonkittie17 in reply to Whiskers64]

I echo what Lola says re the B cell depletion on Rtx and sometimes the depletion can be longer for >12 months which has been my own experience, so there’s that to consider and the current climate with Covid. I understand Azathioprine needs to also have careful planning/timing for any vaccines just as Rtx does. I hope either of these help you to get your RA and respiratory problems under control. There are other HU forums for those conditions and the British Lung Foundation where I hope you can get additional advice and help (although I’m sure you are aware of them) and hope whichever you choose you benefit quickly and feel improvement. x

[Whiskers64 in reply to Neonkittie17]

Thank you for your reply all information helps me decide which treatment is best for me.

[Neonkittie17 in reply to Whiskers64]

I always make a list of pros and cons.

[cathie]

I’ve been on rituximab for about 5 years. No side effects so far. The downside is arrangements around 6 monthly infusions - 2 two weeks apart. They take about 4 hours. I’ve been well monitored with regular blood tests.

[Whiskers64 in reply to cathie]

Thank for your information it’s been very helpful.

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[oldtimer]

I have been on azathioprine for some years now. It's not controlling my flares entirely and I'm on the maximum dose for my weight. My only side effect is the unpleasant nausea especially in the mornings (like being in early pregnancy all the time). I have been offered medication for that, but don't want to take any more pills and I cope with it.

[Whiskers64 in reply to oldtimer]

Thanks for your reply can understand you not wanting to take anymore tablets. Your information has helped. Thanks.

[Adnil53]

I use Rituzimab (Adalimunab) injectionIt’s good however I’ve had a lot of infections so keep having to stop it !

[Whiskers64 in reply to Adnil53]

Thank you for that information it hasn’t been mentioned before so very worthwhile considering.

[Neonkittie17 in reply to Adnil53]

Do you mean Rituximab? That is an entirely different biologic to Adalimumab (Humira).

[Whiskers64 in reply to Neonkittie17]

Yes I definitely mean Rituximab by infusion against Azathioprine (Tablets ) & which sufferers of RA are using & which they find beneficial.

[Neonkittie17 in reply to Whiskers64]

Hi Whiskers, I was referring to Adnil53’s reply re “Rituzimab(Adalimumab)”. I think two different meds are being confused in their post. (“Rituximab” is an infusion and Adalimumab is an injection. )

[Whiskers64 in reply to Neonkittie17]

So sorry about that didn’t mean too question you on your reply about the meds but I hadn’t heard of Adalimumab in Adnil53s reply.

[Neonkittie17 in reply to Whiskers64]

Oh no problem I fully understand but just wanted to say those were two separate meds on the other person’s post. These med names can get very confusing! 😁 Rituximab does give you the freedom to go off for a minimum of 6 months before you return for infusion (it can be a single infusion these days or still two infusions a fortnight apart event six months) and then there would be the more regular tablets with Azathioprine. Rtx can restrict you re your vaccine timings more as your B cells are depleted for 6-12 months and I am not sure tbh how Azathioprine works. I hope you can discuss with your rheumy/nurse.

[Daisy70 in reply to Neonkittie17]

May I ask, can you choose to have RTX or does your Rheumy choose for you? I’m going to be a new starter on biologics.

[MissMinto]

I’ve been on Rituximab for 3 years now without any problems. Do you have any digestive issues?

When I was on Methotrexate tablets they caused havoc with my gut so I switched to the injections and voila! no more gut problems as it goes straight into your blood stream.

I’m the same with steroids, can’t tolerate the tablets but a quick shot in the bum is fine.

I would choose injection or infusion over tablets any day for this very reason.

[Daisy70 in reply to MissMinto]

May I ask, can you choose to have RTX or does your Rheumy choose for you? I’m going to be a new starter on biologics.

[MissMinto in reply to Daisy70]

Essentially it’s a discussion between both you and your consultant in that you can state a preference for one, but ultimately the consultant calls the shots as each of the biologics has a different mechanism and they will match your symptoms to the corresponding biologic.I arrived at Rituximab having had 8 years on Humira which stopped working after I took a break for surgery, followed by a year on Benepali which did nothing.

Good luck 💐

[Whiskers64 in reply to Daisy70]

Yes it’s as Miss Minto has said it’s discussion between you & your Rheumy with me it also involved my Respiratory specialist as my RA has attacked my Lungs as well as my joints & this has affected my breathing so I had the choice of Rituximab infusion or having a tablets for the rest of my life every day on top of what I’m already taking. I chose Rituximab & have just finished my first 1 & 2 infusion this week & then no more for perhaps 6 to 12 months depending on blood tests. For me this was my best choice but not one you can make on your own.