Truxima is a brand-name prescription medication. It’s FDA-approved to treat certain forms of the following conditions in adults:

  • Non-Hodgkin lymphoma. Truxima is used alone and with other drugs to treat different kinds of non-Hodgkin lymphoma (NHL):
    • Truxima alone for B-cell NHL. The cancer must be a type called CD20-positive. It must also be low-grade (slow growing) or a kind known as follicular lymphoma (FL). In addition, the cancer must be relapsed (came back) or refractory (didn’t improve) after treatment. For this use, Truxima is used alone.
    • Truxima with chemotherapy for B-cell NHL. The cancer must be CD20-positive, low-grade or FL, and it must not have been treated before. For this purpose, Truxima is used with chemotherapy. If you have a partial or complete response* to Truxima and chemotherapy, you may go on to use Truxima alone.
    • Truxima after chemotherapy for B-cell NHL. The cancer must be low-grade and CD20-positive. Also, it must be non-progressing. This means that the cancer didn’t get worse after you tried chemotherapy with cyclophosphamide, vincristine, and prednisone (Rayos). For this purpose, you’ll use Truxima alone.
    • Truxima with chemotherapy for diffuse large B-cell lymphoma. The diffuse large B-cell lymphoma (DLBCL) must be CD20-positive and must not have been treated before. For this purpose, Truxima is used with the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy medications known as anthracyclines.
  • Chronic lymphocytic leukemia. Truxima is used with the drugs fludarabine and cyclophosphamide to treat chronic lymphocytic leukemia (CLL) that has or hasn’t been treated before. The CLL must be CD20-positive.
  • Rheumatoid arthritis. Truxima is used with methotrexate (Trexall) to treat rheumatoid arthritis (RA) that’s moderate to severe and active. “Active” means you currently have symptoms. You must have tried at least one medication called a TNF antagonist, but it didn’t improve your RA symptoms or you couldn’t tolerate its side effects.
  • Granulomatosis with polyangiitis. Truxima is used with glucocorticoids to treat a blood vessel disorder called granulomatosis with polyangiitis (GPA).
  • Microscopic polyangiitis. Truxima is used with glucocorticoids to treat a blood vessel disorder known as microscopic polyangiitis (MPA).

* A partial response means the treatment decreased the level of cancer cells to some extent. A complete response means treatment decreased cancer cells to a level that couldn’t be detected in blood tests.

Truxima ingredient and drug class

Truxima contains the active ingredient rituximab-abbs. This means rituximab-abbs is the ingredient that makes Truxima work.

Truxima belongs to a drug class called monoclonal antibodies. A drug class is a group of medications that work in a similar way.

Truxima form and how it’s given

Truxima comes as a solution (liquid mixture) in a single-dose vial. The drug is available in two strengths: 100 mg/10 mL and 500 mg/50 mL.

Truxima is given as an intravenous (IV) infusion. This is an injection into a vein in your arm that’s given over a period of time. A healthcare provider will give you Truxima infusions in a hospital, a clinic, or your doctor’s office.

FDA approval

In 2018, the Food and Drug Administration (FDA) approved Truxima for the treatment of NHL. In early 2019, the FDA approved the drug to treat CLL. Truxima was approved to treat RA, GPA, and MPA later in the year.

Effectiveness

For information on the effectiveness of Truxima, see the “Truxima uses” section below.

Truxima is available only as a brand-name medication. It’s a type of medication called a biosimilar. A biosimilar medication is a drug that’s similar to a brand-name biologic drug. Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. A generic drug, on the other hand, is an exact copy of a brand-name medication that’s made from chemicals.

Biosimilars are sometimes supplied in a different form than their parent biologic drug. However, they’re considered to be just as safe and effective as their parent drug.

Truxima’s parent drug is Rituxan.

Truxima is the first biosimilar of Rituxan that was approved by the Food and Drug Administration (FDA). Rituxan has a second biosimilar called Ruxience.

Truxima contains the active ingredient rituximab-abbs.

The Food and Drug Administration (FDA) approves prescription drugs such as Truxima to treat certain conditions. Truxima may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Truxima for non-Hodgkin lymphoma (NHL)

Truxima is used alone and with other drugs to treat different kinds of non-Hodgkin lymphoma. For the specific uses of Truxima for NHL, see the relevant sections below: “Truxima for B-cell NHL,” “Truxima with chemotherapy for B-cell NHL,” “Truxima for B-cell NHL after chemotherapy,” and “Truxima with other medications for diffuse large B-cell NHL.”

NHL explained

NHL is a type of cancer that affects a part of the immune system (your body’s defense against infection). Specifically, NHL involves white blood cells called lymphocytes. The cancer occurs when the lymphocytes grow out of control. Lymphocytes normally help your body fight off infections and diseases. And lymphocytes known as B cells make antibodies (proteins) that attack germs.

Truxima treats different types of B-cell NHL including low-grade (slow-growing) lymphomas, such as follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). They often affect the lymph nodes (clusters of immune system cells that include lymphocytes). There are lymph nodes throughout the body in areas such as the neck, armpit, chest, stomach, and pelvis.

B-cell NHL can also spread to other parts of the body like the bone marrow or spleen. Symptoms of these cancers can include fever, weight loss, and swollen lymph nodes. Typically, DLBCL is fast growing, and FL is slow growing.

B-cell NHL is often treated with a combination of radiation, chemotherapy, and monoclonal antibodies such as Truxima. Monoclonal antibodies are medications that target specific proteins to help stop or slow the growth of cancer cells.

After finishing your cancer treatment, you may go into remission (have undetectable levels of cancer cells). Your cancer may also relapse (come back) or become refractory (not improve).

Effectiveness of Truxima as a biosimilar

Truxima’s effectiveness for NHL is based on the effectiveness of the drug rituximab. That’s because Truxima, which is a biosimilar, is based on Rituxan (rituximab), which is a biologic. Rituxan is considered to be the parent drug of Truxima.

A biosimilar medication is a drug that’s similar to a brand-name biologic drug. Biologic drugs are made from living cells. (It’s not possible to copy these drugs exactly. A generic drug, on the other hand, is an exact copy of a brand-name medication that’s made from chemicals.)

To be approved by the FDA, a biosimilar needs to be shown that it’s similar to a brand-name biologic drug. Clinical studies comparing the biosimilar with the parent biologic drug must prove that there are no major differences in safety and expected effects in the body.

If no major differences are found, a biosimilar doesn’t need to have new clinical trials done to show its effectiveness. Truxima was found to have no major differences from Rituxan in safety or expected effects in the body. Therefore, the effectiveness data of Truxima for NHL are all based on clinical trials of rituximab. Rituximab is the active ingredient in Truxima’s parent drug, Rituxan.

Truxima for B-cell NHL

Truxima is FDA-approved to be used alone for B-cell NHL. The cancer must be a type called CD20-positive. It must also be low-grade (slow growing) or FL. In addition, the cancer must be relapsed or refractory after treatment.

Effectiveness of Truxima for B-cell NHL

Clinical studies have shown that rituximab (the parent drug of Truxima) was shown to be an effective treatment for FL that’s relapsed or refractory. In these studies, rituximab wasn’t compared with another drug or a placebo (drug with no active ingredient).

Two clinical trials looked at people who received rituximab once a week for 4 weeks. In the first study, researchers found the following:

  • About 48% of the people had a partial or complete response from treatment. A partial response means the treatment decreased the level of cancer cells to some extent. A complete response means treatment decreased cancer cells to a level that couldn’t be detected in blood tests.
  • About 6% of the people had a complete response from the treatment.
  • About 11.2 months after having response from the treatment, half of the people with FL saw their cancer progress (got worse).

In the second study, about 38% of people had a partial or complete response and 10% had a complete response. At about 15 months, cancer for half of the people had gotten worse.

In another study, people received rituximab once a week for 8 weeks. Researchers found the following:

  • About 57% of the people had a partial or complete response.
  • 14% of people had a complete response.
  • For half of the people who took rituximab, their NHL got worse about 13.4 months after they had a partial or complete response.

Truxima with chemotherapy for B-cell NHL

Truxima is FDA-approved to be used with chemotherapy for B-cell NHL. The cancer must be CD20-positive, low-grade (slow-growing) or FL, and it must not have been treated before. For this purpose, Truxima is used with chemotherapy.

If you had at least some response to rituximab and chemotherapy, then you may go on to use Truxima alone. A partial response means the level of cancer cells is lower. And a complete response means the cancer cells decreased to a level that couldn’t be detected in blood tests.

Effectiveness of Truxima with chemotherapy for B-cell NHL

Truxima is an effective treatment for B-cell NHL that hadn’t been treated before.

One clinical trial looked at rituximab (the parent drug of Truxima). Some people were given rituximab and the drugs cyclophosphamide, vincristine, and prednisone (Rayos). Together, cyclophosphamide, vincristine, and prednisone are known as a cancer treatment called CVP. Other people were given CVP without rituximab.

Researchers found the following:

  • For half of the people who received rituximab and CVP, it was 2.4 years before their cancer got worse.
  • In comparison, in half of the people who received CVP alone, it was 1.4 years before their cancer started getting worse.

Truxima for B-cell NHL after chemotherapy

Truxima is FDA-approved to be used after chemotherapy for B-cell NHL. The cancer must be low-grade and CD20-positive. Also, it must be non-progressing. This means that the cancer didn’t get worse after you tried chemotherapy with cyclophosphamide, vincristine, and prednisone. For this purpose, you’ll use Truxima alone.

Effectiveness of Truxima for B-cell NHL after chemotherapy

Rituximab was shown to be effective in treating FL and other low-grade B-cell NHL after chemotherapy. (FL is a type of B-cell NHL.)

One study looked at people who received chemotherapy and rituximab (the parent drug of Truxima) as their first treatment. If the treatment worked, some people kept receiving rituximab alone once every 8 weeks for up to 12 weeks. Other people were observed but didn’t have the follow-up treatment. Researchers found that the cancer in people who received rituximab alone was 46% less likely to get worse. This was compared with people who didn’t have the follow-up treatment.

Another study looked at people whose cancer was stable after they received six or eight cycles of chemotherapy for the first time. The treatment included the drugs cyclophosphamide, vincristine, and prednisone.

Some people received rituximab once a week for 4 weeks every 6 months. This was repeated four times. Other people didn’t receive this follow-up treatment.

At the end of the study, NHL was 51% to 64% less likely to progress in people who received rituximab, compared with people who didn’t receive follow-up treatment.

Truxima with other medications for diffuse large B-cell NHL (DLBCL)

Truxima is FDA-approved to be used with chemotherapy for diffuse large B-cell lymphoma. The DLBCL must be CD20-positive and must not have been treated before. For this purpose, Truxima is used with the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy medications known as anthracyclines.

Effectiveness of Truxima with other medications for DLBCL

Rituximab was shown to be an effective treatment in previously untreated DLBCL.

In one clinical trial, people were given rituximab and chemotherapy called CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or just CHOP alone. Researchers found the following:

  • For half of the people who received rituximab and CHOP, it took at least 3.1 years before their cancer got worse.
  • In comparison, for half of the people who received CHOP alone, it took at least 1.6 years before their cancer started getting worse.

In another clinical trial, half of the people who received rituximab and CHOP were stable for 2.9 years. “Stable” means that their condition didn’t get worse or lead to death, and their treatment didn’t change. In comparison, for half of the people who received CHOP alone, it took 1.1 years before their cancer came back or got worse.

In a different study, some people received rituximab in combination with a chemotherapy that was similar to CHOP. Other people in the study received just chemotherapy.

  • DLBCL was 55% less likely to get worse in people who received rituximab and chemotherapy, compared with people who received just chemotherapy.

Truxima for chronic lymphocytic leukemia (CLL)

Truxima is FDA-approved to treatchronic lymphocytic leukemia that has or hasn’t been treated before. The CLL must be a type called CD20-positive. In this case, Truxima is used with the chemotherapy drugs fludarabine and cyclophosphamide.

CLL explained

CLL is a type of cancer that starts in the bone marrow. It affects the cells that will become lymphocytes (white blood cells that help fight infections and diseases). With CLL, too many abnormal lymphocyte cells build up.

CLL grows very slowly, so you may not notice any symptoms at first. But over time, the abnormal cells move into the blood and even spread to other organs like the lymph nodes, liver, and spleen. This can cause symptoms such as weakness, tiredness, weight loss, fever, and swollen lymph nodes.

You may go into remission (have undetectable levels of cancer cells) after finishing your cancer treatment. Your cancer may also relapse (come back) or become refractory (not improve). If this happens, you may receive the same or a different cancer treatment.

Effectiveness for CLL

Rituximab has been shown to be an effective treatment for CLL.

Clinical trials studied rituximab (parent drug of Truxima) in people with CLL who received two cancer treatments: fludarabine and cyclophosphamide. For six cycles of treatment, people received either just these two drugs or these two drugs along with rituximab.

One study looked at people who had never received cancer treatment in the past. Researchers found that:

  • For half of the people who received Truxima and the two other drugs, it took 39.8 months until the CLL got worse.
  • For half of the people who received just fludarabine and cyclophosphamide, it took 31.5 months until the CLL got worse.

Another study looked at people who did receive cancer treatment in the past. Researchers found that:

  • For half of the people who received Truxima, it took 26.7 months until the CLL got worse.
  • For half of the people who received just fludarabine and cyclophosphamide, it took 21.7 months until the CLL got worse.

Truxima for rheumatoid arthritis (RA)

Truxima is FDA-approved to treat rheumatoid arthritis that’s active and moderate to severe. “Active” means you currently have symptoms. Moderate-to-severe RA means that your symptoms are starting to affect your ability to move and do everyday activities.

Before trying Truxima, you must have tried at least one medication called a tumor necrosis factor (TNF) antagonist, but it didn’t improve your RA symptoms or you couldn’t tolerate its side effects. Examples of TNF antagonists include adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel).

Truxima is used in combination with methotrexate (Trexall).

RA explained

RA is a long-term autoimmune disease. With RA, your immune system mistakenly attacks the lining of your joints. If left untreated, this damages your joints and makes them swollen, stiff, and painful. RA often affects the hands, knees, or ankles on both sides of the body. But it can also affect other parts of the body like the heart and lungs.

Effectiveness for RA

Current studies show that Truxima may be an effective treatment RA. The drug helps improve pain, slow down RA from worsening, and reduce the damage to the joints.

In a clinical study, people who received rituximab and methotrexate were compared with people who took a placebo (treatment with no active drug) and methotrexate. The study used the American College of Rheumatology (ACR) classification criteria to find out how effective rituximab was for treating RA.

An ACR50 measures the number of people who received the medication and had at least a 50% improvement in their RA symptoms and function. After 24 weeks, an ACR50 was reported in:

  • 27% of people who received rituximab and methotrexate
  • 5% of people who received a placebo and methotrexate

Another study compared people who were re-treated with rituximab and methotrexate. People received rituximab and methotrexate for 24 weeks. Of those people whose RA didn’t improve, people received either rituximab and methotrexate or a placebo and methotrexate for another 24 weeks.

After 48 weeks, an ACR50 was reported in:

  • 29% of people who received rituximab and methotrexate
  • 26% of people who received a placebo and methotrexate

Truxima for granulomatosis with polyangiitis (GPA)

Truxima is FDA-approved to treat granulomatosis with polyangiitis in adults. In this case, Truxima is used with drugs called glucocorticoids.

GPA is a condition in which the immune system mistakenly attacks the blood vessels. This causes vasculitis (inflammation of blood vessels). The inflammation can narrow the small blood vessels, making it harder for blood to flow through.

With GPA, the limited blood flow can damage organs like the sinuses, eyes, lungs, and kidneys. Initial symptoms may include joint pain, feeling weak and tired, and cold symptoms such as a runny nose that doesn’t get better.

Effectiveness for GPA

Rituximab is shown to be effective in treating GPA.

A clinical trial looked at people with GPA or another type of blood vessel condition called microscopic polyangiitis (MPA). The people were given Truxima and methylprednisolone (Medrol) or cyclophosphamide and methylprednisolone. Researchers observed the percentage of people who reached complete remission (no detectable symptoms of inflammation).

After 6 months of treatment, remission was reported in:

  • 64% of people who received rituximab and methylprednisolone
  • 53% of people who received cyclophosphamide and methylprednisolone

Truxima for microscopic polyangiitis (MPA)

Truxima is FDA-approved to treat microscopic polyangiitis in adults.In this case, Truxima is used with medications called glucocorticoids.

MPA is a condition in which the immune system mistakenly attacks the small blood vessels. This causes vasculitis (inflammation of blood vessels). The inflammation can narrow the blood vessels, making it harder for blood to flow through.

MPA often affects the kidneys, lungs, nerves, skin, and joints. The most common symptoms include kidney inflammation, weight loss, skin redness, nerve damage, and fever.

Effectiveness for MPA

Truxima is effective in treating MPA. For study results, please see the “Effectiveness for GPA” section above.

Off-label uses for Truxima

In addition to the uses listed above, Truxima may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved. Below are examples of off-label uses for Truxima.

Truxima for multiple sclerosis (MS)

Truxima isn’t FDA-approved to treat multiple sclerosis right now. However, the drug may be used off-label for this purpose.

MS is a long-term condition that affects your central nervous system (CNS), which includes the brain, spinal cord, and nerves in the eyes. With MS, your immune system mistakenly attacks the nerves in your CNS. This causes inflammation and scar tissue to form around your nerve fibers.

When the nerve fibers are damaged, your brain has a hard time communicating with the rest of your body. Symptoms can vary, but people with MS may lose the ability to write, speak, or walk.

Based on a review of studies, rituximab (the parent drug of Truxima) has been shown to be an effective treatment for two types of MS: relapse-remitting MS and progressive MS.

If you have questions about using Truxima for MS, talk with your doctor.

Truxima for lupus

Truxima isn’t currently FDA-approved to treat lupus. However, the drug may be used off-label for this purpose.

Lupus is an autoimmune disease in which the immune system mistakenly attacks healthy tissue. It can affect various parts of the body like the skin, joints, kidneys, brain, and other organs.

Lupus nephritis is a complication of lupus. It occurs when your immune system attacks your kidneys. Lupus nephritis can cause serious kidney problems, such as kidney failure.

Although more research is needed, a review of studies done so far shows that Truxima may be an effective treatment for lupus and lupus nephritis.

If you have questions about using Truxima for lupus, talk with your doctor.

Truxima for primary immune thrombocytopenia (ITP)

Currently, Truxima isn’t FDA-approved to treat primary immune thrombocytopenia. However, the drug may be used off-label for this purpose.

ITP is an autoimmune disease in which the immune system mistakenly attacks platelets. These are blood cells that help with blood clotting. ITP lowers the level of platelets, which makes you more likely to bleed and bruise.

A review of studies showed that rituximab was effective in treating ITP.

If you have questions about using Truxima for ITP, talk with your doctor.

Truxima and children

It’s not known if Truxima is safe or effective for use in children.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Truxima, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed below are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for non-Hodgkin lymphoma

Examples of other drugs that may be used to treat non-Hodgkin lymphoma include:

Alternatives for chronic lymphocytic leukemia

Examples of other drugs that may be used to treat chronic lymphocytic leukemia include:

  • bendamustine (Treanda)
  • chlorambucil (Leukeran)
  • cyclophosphamide
  • duvelisib (Copiktra)
  • fludarabine
  • ibrutinib (Imbruvica)
  • idelalisib (Zydelig)
  • obinutuzumab (Gazyva)
  • prednisone (Rayos)
  • rituximab (Rituxan)
  • rituximab/hyaluronidase (Rituxan Hycela)
  • venetoclax (Venclexta)

Alternatives for rheumatoid arthritis

Examples of other drugs that may be used to treat rheumatoid arthritis include:

Alternatives for granulomatosis with polyangiitis

Examples of other drugs that may be used to treat granulomatosis with polyangiitis include:

Alternatives for microscopic polyangiitis

Examples of other drugs that may be used to treat microscopic polyangiitis include:

  • azathioprine (Imuran)
  • prednisone (Rayos)
  • cyclophosphamide
  • methotrexate (Trexall)

You may wonder how Truxima compares with other medications that are prescribed for similar uses. Here we look at how Truxima and rituximab (Rituxan) are alike and different.

Uses

The Food and Drug Administration (FDA) has approved Truxima and Rituxan to treat certain forms of the following conditions in adults:

  • Non-Hodgkin lymphoma. Truxima and Rituxan are used by themselves and with other drugs to treat different kinds of non-Hodgkin lymphoma (NHL):
    • Truxima or Rituxan alone for B-cell NHL. The cancer must be a type called CD20-positive. It must also be low-grade (slow growing) or a kind known as follicular lymphoma (FL). In addition, the cancer must be relapsed (came back) or refractory (didn’t improve) after treatment. For this use, Truxima or Rituxan is used alone.
    • Truxima or Rituxan with chemotherapy for B-cell NHL. The cancer must be CD20-positive, low-grade or FL, and it must not have been treated before. For this purpose, Truxima or Rituxan is used with chemotherapy. If you have a partial or complete response* to Truxima or Rituxan and chemotherapy, then you may go on to use Truxima or Rituxan alone.
    • Truxima or Rituxan after chemotherapy for B-cell NHL. The cancer must be low-grade and CD20-positive. Also, it must be non-progressing. This means that the cancer didn’t get worse after you tried chemotherapy with cyclophosphamide, vincristine, and prednisone (Rayos). For this purpose, you’ll use Truxima or Rituxan alone.
    • Truxima or Rituxan with chemotherapy for diffuse large B-cell lymphoma. The diffuse large B-cell lymphoma (DLBCL) must be CD20-positive and must not have been treated before. For this purpose, Truxima or Rituxan is used with the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy medications known as anthracyclines.
  • Chronic lymphocytic leukemia. Truxima or Rituxan is used with the drugs fludarabine and cyclophosphamide to treat adults with chronic lymphocytic leukemia (CLL) that has or hasn’t been treated before. The CLL must be CD20-positive.
  • Rheumatoid arthritis. Truxima or Rituxan is used with methotrexate (Trexall) to treat adults with rheumatoid arthritis (RA) that’s moderate to severe and active. “Active” means you currently have symptoms. You must have tried at least one medication called a TNF antagonist, but it didn’t improve your RA symptoms or you couldn’t tolerate its side effects.
  • Granulomatosis with polyangiitis. Truxima or Rituxan is used with glucocorticoids to treat a blood vessel disorder called granulomatosis with polyangiitis (GPA). Truxima is approved for use in adults, while Rituxan is approved for use in adults as well as children ages 2 years and older.
  • Microscopic polyangiitis. Truxima or Rituxan is used with glucocorticoids to treat a blood vessel disorder known as microscopic polyangiitis (MPA). For this condition, Truxima is approved for use in adults, while Rituxan is approved for use in adults as well as children ages 2 years and older.

* A partial response means the treatment decreased the level of cancer cells to some extent. A complete response means treatment decreased cancer cells to a level that couldn’t be detected in blood tests.

In addition, Rituxan is approved to treat certain forms of pemphigus vulgaris.

Effectiveness and side effects

Truxima and Rituxan both contain the same active drug, rituximab. And both drugs are given as an intravenous (IV) infusion. This is an injection into a vein in your arm that’s given over a period of time. A healthcare provider will give you the infusions in a hospital, a clinic, or your doctor’s office.

Truxima is a biosimilar of Rituxan. A biosimilar medication is a drug that’s similar to a brand-name biologic drug. Biologic drugs are made from living cells. It’s not possible to copy these drugs exactly. However, they are very similar and considered to be just as safe and effective as their parent drug. Rituxan is the parent drug of Truxima.

The FDA considers Truxima to be just as safe and effective as Rituxan in treating the forms of B-cell NHL, CLL, RA, GPA, and MPA mentioned above.

Costs

According to estimates on WellRx.com, Truxima costs significantly less than Rituxan. The actual price you’ll pay for either drug depends on your insurance plan and your location.

Many typical drugs that are made from chemicals have generic versions. A generic medication is an exact copy of the active ingredient in a brand-name drug. It often costs less than the brand-name version.

However, Truxima is a biosimilar. A biosimilar is a drug that’s similar to a biologic drug. Biologic medications are made from parts of living organisms. Instead of generics, biologic drugs have biosimilars.

Rituxan is a biologic drug. It has two biosimilar versions: Truxima and Ruxience.

Like generics, biosimilars often cost less than the brand-name biologic they’re based on.

You may wonder how Truxima compares with other medications that are prescribed for similar uses. Here we look at how Truxima and Gazyva are alike and different.

Ingredients

The active drug ingredient in Truxima is rituximab-abbs. The active drug ingredient in Gazyva is obinutuzumab.

Uses

The Food and Drug Administration (FDA) has approved Truxima to treat certain forms of the following conditions in adults:

  • Non-Hodgkin lymphoma. Truxima is used alone and with other drugs to treat different kinds of non-Hodgkin lymphoma (NHL):
    • Truxima alone for B-cell NHL. The cancer must be a type called CD20-positive. It must also be low-grade (slow growing) or a kind known as follicular lymphoma (FL). In addition, the cancer must be relapsed (came back) or refractory (didn’t improve) after treatment. For this use, Truxima is used alone.
    • Truxima with chemotherapy for B-cell NHL. The cancer must be CD20-positive, low-grade or FL, and it must not have been treated before. For this purpose, Truxima is used with chemotherapy. If you have a partial or complete response* to Truxima and chemotherapy, you may go on to use Truxima alone.
    • Truxima after chemotherapy for B-cell NHL. The cancer must be low-grade and CD20-positive. Also, it must be non-progressing. This means that the cancer didn’t get worse after you tried chemotherapy with cyclophosphamide, vincristine, and prednisone (Rayos). For this purpose, you’ll use Truxima alone.
    • Truxima with chemotherapy for diffuse large B-cell lymphoma. The diffuse large B-cell lymphoma (DLBCL) must be CD20-positive and must not have been treated before. For this purpose, Truxima is used with the drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, or with other chemotherapy medications known as anthracyclines.
  • Chronic lymphocytic leukemia. Truxima is used with the drugs fludarabine and cyclophosphamide to treat chronic lymphocytic leukemia (CLL) that has or hasn’t been treated before. The CLL must be CD20-positive.
  • Rheumatoid arthritis. Truxima is used with methotrexate (Trexall) to treat rheumatoid arthritis (RA) that’s moderate to severe and active. “Active” means you currently have symptoms. You must have tried at least one medication called a TNF antagonist, but it didn’t improve your RA symptoms or you couldn’t tolerate its side effects.
  • Granulomatosis with polyangiitis. Truxima is used with glucocorticoids to treat a blood vessel disorder called granulomatosis with polyangiitis (GPA).
  • Microscopic polyangiitis. Truxima is used with glucocorticoids to treat a blood vessel disorder known as microscopic polyangiitis (MPA).

* A partial response means the treatment decreased the level of cancer cells to some extent. A complete response means treatment decreased cancer cells to a level that couldn’t be detected in blood tests.

Gazyva is currently FDA-approved to treat the following conditions:

  • CLL that hasn’t been treated before. In this case, Gazyva is used with chlorambucil (Leukeran).
  • FL that’s relapsed or refractory. You must have tried rituximab as part of the treatment. You’ll first use Gazyva with bendamustine (Treanda), then use Gazyva alone.
  • FL that hasn’t been treated before. Gazyva is used for these forms of FL: stage II bulky, III, or IV. Gazyva is used with chemotherapy, and if your FL goes into at least partial remission, you’ll keep using just Gazyva alone. Partial remission is when the cancer is still there but you have fewer cancer cells in your body.

Drug forms and administration

Truxima and Gazyva are both given as an intravenous (IV) infusion. This is an injection into a vein in your arm that’s given over a period of time. A healthcare provider will give you the infusions in a hospital, a clinic, or your doctor’s office.

Side effects and risks

Truxima and Gazyva are both in the same drug class. (A drug class is a group of medications that work in a similar way.) Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Truxima, with Gazyva, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Truxima, with Gazyva, or with both drugs (when taken individually).

1. Truxima has boxed warnings for these side effects. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more information, see “FDA warnings” at the beginning of this article.

2. Gazyva has boxed warnings for these side effects. A boxed warning is the most serious warning from the FDA.

Effectiveness

Truxima and Gazyva have slightly different FDA-approved uses, but they’re both used to treat certain types of FL and CLL.

The two drugs haven’t been directly compared in clinical studies, but studies have found both Truxima and Gazyva to be effective for treating FL and CLL.

Gazyva was compared with Rituxan, the parent drug of Truxima, in clinical studies of Gazyva. Studies found that both drugs were effective for treating FL and CLL. For details on comparisons between Gazyva and Rituxan, please see the prescribing information for Gazyva.

Costs

According to estimates on WellRx.com, Truxima costs significantly less than Gazyva. The actual price you’ll pay for either drug depends on your insurance plan and your location.

Many typical drugs that are made from chemicals have generic versions. A generic medication is an exact copy of the active ingredient in a brand-name drug. It often costs less than the brand-name version.

However, Truxima is a biosimilar. A biosimilar is a drug that’s similar to a biologic drug. Biologic medications are made from parts of living organisms. Instead of generics, biologic drugs have biosimilars.

Gazyva is a biologic drug. It doesn’t have a biosimilar version.

Like generics, biosimilars often cost less than the brand-name biologic they’re based on.

Truxima can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Truxima. These lists don’t include all possible side effects.

For more information on the possible side effects of Truxima, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Truxima, you can do so through MedWatch.

Mild side effects

Mild side effects of Truxima can include:*

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Truxima. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Truxima’s Medication Guide.

Serious side effects

Serious side effects from Truxima aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* Truxima has a boxed warning for reactivation of hepatitis B virus and PML. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more information, see “FDA warnings” at the beginning of this article.

Other serious side effects, explained in more detail below in “Side effect details,” include:

  • allergic reaction
  • severe infusion reactions, such as chest pain*
  • severe infections, such as pneumonia
  • severe reactions of the skin and mucous membranes (tissues that protect parts of the body with mucus)*

* Truxima has boxed warnings for these side effects. A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on some of the side effects this drug may cause.

Boxed warnings

Truxima has several boxed warnings about possible risks of taking the medication. A boxed warning is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Truxima. It’s not known how many people in clinical trials had allergic reactions.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Truxima. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Infusion reactions

It’s common for Truxima to cause infusion reactions, and some of these may be serious.* Rates of infusion reactions varied depending on the type of condition Truxima was used to treat.

Clinical trials compared rituximab (the parent drug of Truxima) with a placebo (treatment with no active drug) to treat rheumatoid arthritis (RA). Infusion reactions were reported in:

  • 27% of people who received rituximab with their first dose
  • 19% of people who received a placebo with their first dose

Symptoms of an infusion reaction can include:

  • hives (red itchy welts) or rash
  • itchy skin
  • swelling of your lips, tongue, throat, or face
  • coughing suddenly
  • trouble breathing or wheezing
  • weakness
  • feeling dizzy or lightheaded
  • palpitations (feeling like your heart is beating fast)
  • chest pain

Infusion reactions are most likely to occur about 30 minutes to 2 hours after you start receiving your first dose. You’re less likely to have infusion reactions with each following dose. Infusion reactions can also occur within 24 hours of your first infusion.

Monitoring for infusion reactions

Your doctor will monitor you while you’re receiving Truxima. Depending on any infusion reactions you have, your doctor may infuse your dose more slowly so your body has time to adjust to the medication. You may need to take a break from your infusion until your symptoms improve.

If your reaction is severe, your doctor may have you stop using Truxima and switch to another treatment.

Preventing infusion reactions

Your doctor will give you medications before each dose of Truxima to reduce your risk for having an infusion reaction. You’ll likely receive a medication to reduce fever, such as acetaminophen (Tylenol). To help prevent rash and other allergy-like symptoms, you may also receive an antihistamine medication, such as diphenhydramine (Benadryl).

People with RA, granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA) will also receive a steroid, such as methylprednisolone (Medrol), intravenously 30 minutes before each Truxima infusion.

If you have any questions about infusion reactions, talk with your doctor.

* Truxima has a boxed warning for infusion reactions. This is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Blood disorders

Truxima has been shown to cause blood disorders, such as abnormally low levels of white blood cells and red blood cells.

Neutropenia

Clinical trials showed that Truxima can cause neutropenia in people with chronic lymphocytic leukemia (CLL). Neutropenia is a condition in which you have a low level of white blood cells known as neutrophils. Some people had neutropenia that didn’t go away within 24 to 42 days after their last dose treatment. This is called prolonged neutropenia. Others had late-onset neutropenia, which is neutropenia that started at least 42 days after the last treatment.

Researchers looked at people with CLL who hadn’t had previous treatment. For this study, some people received rituximab with the chemotherapy drugs fludarabine and cyclophosphamide. Together, these two drugs are referred to as FC. Other people received FC alone. The results showed that:

  • About 8.5% of people who received rituximab and FC had prolonged neutropenia. This was compared with 5.8% of people who received FC alone.
  • Late-onset neutropenia was seen in 14.8% of people who received rituximab and FC. In comparison, it was seen in 4.3% of people who received FC.

For people with CLL who received chemotherapy in the past, researchers found the following:

  • About 24.8% of people who received rituximab and FC had prolonged neutropenia. This was compared with 19.1% of people who received FC alone.
  • Late-onset neutropenia was seen in 38.7% of people who received rituximab and FC and in 13.6% of people who received FC.

For people who took Truxima for other forms of NHL, as well as for rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), the rates of blood disorders varied.

Symptoms of a decreased level of white blood cells

White blood cells help fight off germs in your body. Symptoms of a decreased level of white blood cells can include:

  • infections that keep coming back or won’t go away
  • feeling tired
  • mouth sores

Your doctor will monitor your blood levels routinely while you receive Truxima.

Anemia

Low levels of red blood cells were observed in some people who received Truxima.

A clinical study looked at people with non-Hodgkin lymphoma (NHL) that hadn’t been previously treated. For the study, after completing a treatment with cyclophosphamide, vincristine, and prednisone (Rayos), they received rituximab alone or no further medication. Anemia was reported in:

  • 35% of people who received Truxima
  • 20% of people who received no further medication

For people who took Truxima for other forms of NHL, as well as for rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), the rates of anemia varied.

Symptoms of anemia

Red blood cells help carry oxygen to different areas of your body. Having a low level of red blood cells can result in symptoms including:

  • feeling dizzy or lightheaded
  • having trouble focusing
  • feeling more tired than usual
  • having an unusual craving, such as for ice, clay, or dirt

Talk with your doctor if you notice any of these symptoms while using Truxima.

Infections

People receiving Truxima are more likely to get infections. Clinical studies looked at people with NHL who hadn’t been previously treated. After completing a treatment with CVP, they received rituximab (the parent drug of Truxima) alone or no further medication. Infections were reported in:

  • 19% to 37% of people who received rituximab
  • 9% to 22% of people who received no further medication

For people who received Truxima for other forms of NHL (as well as for RA, GPA, or MPA), the rates of infections varied.

Infections are more likely to occur with Truxima use because the drug can weaken your immune system. This makes it harder to fight off germs. Serious bacterial, fungal, and viral infections can happen, and they can sometimes result in death.

Reactivation of viruses

Truxima may also reactivate viruses you’ve had in the past. So if you’ve had a viral infection or are a carrier of a virus, using Truxima may make the virus active. (A carrier is someone who has a virus but shows no symptoms.) Some of these viruses include:

Symptoms of infections

Symptoms of infections include:

Call your doctor right away if you have any of the above symptoms while using Truxima. They can be signs of a serious infection.

* Truxima has a boxed warning for reactivation of hepatitis B virus. This is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

Skin and mucous membrane reactions

Truxima can cause skin-related reactions and mucocutaneous reactions.* It’s not known how many people who received Truxima had this side effect.

Mucocutaneous reactions are conditions that affect the mucus membranes (tissues that protect parts of the body with mucus). These areas can include the mouth, the inside of the nose or ears, and the stomach. The skin reactions can be severe, in some cases leading to death.

Symptoms of the skin-related reactions can include any of the following on your skin or lips, or inside your mouth:

  • painful sores
  • blisters
  • peeling skin
  • rash
  • pustules

If you develop any of these symptoms while using Truxima, call your doctor right away.

* Truxima has a boxed warning for severe skin and mouth reactions. This is the most serious warning from the FDA. For more information, see “FDA warnings” at the beginning of this article.

The Truxima dosage your doctor prescribes will depend on several factors. These include:

  • the type of the condition you’re using Truxima to treat
  • your height and weight
  • other treatments you may be receiving

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Truxima comes as a solution (liquid mixture) in a single-dose vial. The drug is available in two strengths: 100 mg/10 mL and 500 mg/50 mL.

Truxima is given as an intravenous (IV) infusion. This is an injection into a vein in your arm that’s given over a period of time. A healthcare provider will give you Truxima infusions in a hospital, a clinic, or your doctor’s office.

Dosage for non-Hodgkin lymphoma (NHL)

Truxima is used to treat various types and forms of non-Hodgkin lymphoma.

Before each dose of Truxima, you’ll likely receive medications to help prevent infusion reactions. (For more about infusion reactions, see the “Truxima side effects” section above.) These medications include acetaminophen (Tylenol) and an antihistamine, such as diphenhydramine (Benadryl).

Dosage for B-cell NHL

Truxima is used for B-cell NHL that’s CD20-positive. The cancer must also be low-grade (slow growing) or a kind known as follicular lymphoma (FL). In addition, the cancer must be relapsed (came back) or refractory (didn’t improve) after treatment.

The recommended dose of Truxima is an infusion of 375 mg/m2* in these situations:

  • For NHL that has gotten worse or isn’t getting better, you’ll receive an infusion once a week for 4 or 8 weeks.
  • For NHL that has gotten worse or isn’t getting better and is being treated again with Truxima, you’ll receive an infusion once a week for 4 weeks.

When Truxima is given as part of a treatment that includes ibritumomab tiuxetan (Zevalin), the recommended dose is an infusion of 250 mg/m2* on day 1, then again on day 7, 8, or 9.

* m2 stands for “metered squared.” This is a measurement of your body surface area (BSA), which is based on your height and weight. Your doctor will determine the right dose of Truxima for you based on your BSA.

Dosage with chemotherapy for B-cell NHL

Truxima is used with chemotherapy for B-cell NHL. The NHL must be FL and CD20-positive, and it must not have been treated before.

On the first day of each chemotherapy cycle, you’ll receive a Truxima infusion of 375 mg/m2* for up to eight doses.

If you have a partial or complete response to the Truxima and chemotherapy treatment, you’ll receive an infusion of just Truxima once every 8 weeks for 12 doses.A partial response means the level of cancer cells is lower. And a complete response means the cancer cells decreased to a level that couldn’t be detected in blood tests.

* m2 stands for “metered squared.” This is a measurement of your body surface area (BSA), which is based on your height and weight. Your doctor will determine the right dose of Truxima for you based on your BSA.

Dosage for B-cell NHL after chemotherapy

Truxima is used after chemotherapy for B-cell NHL. The cancer must be low-grade and CD20-positive. Also, it must be non-progressing. This means that the cancer didn’t get worse after you tried the chemotherapy drugs cyclophosphamide, vincristine, and prednisone (Rayos).

If the cancer didn’t get worse after six to eight cycles of treatment with the chemotherapy drugs mentioned above, the Truxima dosage is as follows: You’ll receive an infusion of 375 mg/m2* once a week for four doses. You’ll have the infusions at 6 months apart for up to 16 doses.

* m2 stands for “metered squared.” This is a measurement of your body surface area (BSA), which is based on your height and weight. Your doctor will determine the right dose of Truxima for you based on your BSA.

Dosage with other medications for diffuse large B-cell NHL

Truxima is used for diffuse large B-cell lymphoma (DLBCL) that’s CD20-positive and hasn’t been treated before. You’ll receive Truxima with the chemotherapy drugs cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or with other chemotherapy medications known as anthracyclines.

On the first day of each treatment with CHOP or the anthracycline, you’ll receive a Truxima infusion of 375 mg/m2.* This can be repeated for up to eight infusions.

* m2 stands for “metered squared.” This is a measurement of your body surface area (BSA), which is based on your height and weight. Your doctor will determine the right dose of Truxima for you based on your BSA.

Dosage for chronic lymphocytic leukemia (CLL)

Truxima is used for chronic lymphocytic leukemia that’s CD20-positive and has or hasn’t been treated. Truxima is used with the chemotherapy drugs fludarabine and cyclophosphamide.

The day before you start having chemotherapy, you’ll receive an infusion of 375 mg/m2* of Truxima.

On the first day of treatment cycles 2 to 6, you’ll receive an infusion of 500 mg/m2* of Truxima. Each cycle lasts 28 days.

Before each dose of Truxima, you’ll likely receive medications to help prevent infusion reactions. (For more about infusion reactions, see the “Truxima side effects” section above.) These medications include acetaminophen and an antihistamine, such as diphenhydramine.

* m2 stands for “metered squared.” This is a measurement of your body surface area (BSA), which is based on your height and weight. Your doctor will determine the right dose of Truxima for you based on your BSA.

Dosage for rheumatoid arthritis (RA)

Truxima is used with methotrexate (Trexall) to treat rheumatoid arthritis that’s moderate to severe and active. “Active” means you currently have symptoms. You must have tried at least one medication called a TNF antagonist, but it didn’t improve your RA symptoms or you couldn’t tolerate its side effects.

You’ll first receive an infusion of 1,000 mg of Truxima. Then you’ll receive this dose 2 weeks later. After that, you’ll receive the infusion once every 16 to 24 weeks. How often you receive Truxima will be based on how well you respond to the treatment.

Before each dose of Truxima, you’ll likely receive medications to help prevent infusion reactions. (For more about infusion reactions, see the “Truxima side effects” section above.) For RA, these medications include acetaminophen; an antihistamine, such as diphenhydramine; and a steroid, such as methylprednisolone (Medrol) or a similar treatment.

Dosage for granulomatosis with polyangiitis (GPA)

Truxima is used with glucocorticoids to treat a blood vessel disorder called granulomatosis with polyangiitis.

You’ll first receive a Truxima infusion of 375 mg/m2* once a week for 4 weeks.

If your symptoms disappear after the first 4 weeks of treatment, you’ll receive a Truxima infusion of 500 mg and repeat this dose in 2 weeks. You’ll then receive a 500-mg infusion every 6 months based on how your body responds to the treatment.

If your symptoms disappear after receiving other forms of rituximab (the active drug for Truxima), you’ll receive Truxima 16 to 24 weeks after your last dose of the rituximab medication.

If your symptoms disappear from receiving other medication to treat GPA, such as azathioprine, you’ll start receiving Truxima within 4 weeks from when you’re symptom-free.

Before each dose of Truxima, you’ll likely receive medications to help prevent infusion reactions. (For more about infusion reactions, see the “Truxima side effects” section above.) These medications include acetaminophen; an antihistamine, such as diphenhydramine; and a steroid, such as methylprednisolone or a similar treatment.

* m2 stands for “metered squared.” This is a measurement of your body surface area (BSA), which is based on your height and weight. Your doctor will determine the right dose of Truxima for you based on your BSA.

Dosage for microscopic polyangiitis (MPA)

Truxima is used with glucocorticoids to treat a blood vessel disorder called microscopic polyangiitis.

The dosage information for MPA is the same as for GPA. Please refer to the “Dosage for granulomatosis with polyangiitis” section above.

What if I miss an infusion appointment?

If you miss an appointment to receive your infusion, call your doctor’s office as soon as possible to reschedule your dose. The staff may need to adjust the timing of future visits.

To help make sure that you don’t miss an appointment, try setting a reminder on your phone. You can also write down your treatment schedule on a calendar.

Will I need to use this drug long term?

Truxima is sometimes meant to be used long term. You doctor will determine how long you should use it based on how well the medication works to treat your condition and any side effects that you may have.

Truxima is sometimes used along with other drugs to help treat cancer. The type of cancer that you have will determine what other medications you’ll need. Truxima may be used with other drugs such as:

  • fludarabine
  • cyclophosphamide
  • doxorubicin
  • vincristine
  • prednisone (Rayos)
  • ibritumomab tiuxetan (Zevalin)

If you have rheumatoid arthritis (RA), you’ll take Truxima along with methotrexate (Trexall) to treat your condition.

In you have granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), you’ll take Truxima along with a steroid medication, such as methylprednisolone (Medrol) or prednisone.

Before each dose of Truxima, you’ll likely receive medications to help prevent infusion reactions. (For more about infusion reactions, see the “Truxima side effects” section above.) These medications include acetaminophen (Tylenol) and an antihistamine, such as diphenhydramine (Benadryl). If you have RA, GPA, or MPA, you’ll also receive a steroid, such as methylprednisolone or a similar treatment.

It’s not known if consuming alcohol is safe while you receive Truxima. Talk with your doctor before drinking alcohol during your treatment.

Truxima may interact with other medications. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

No supplements or foods have been known to interact with Truxima.

In people with chronic lymphocytic leukemia (CLL), Truxima didn’t change the level of fludarabine or cyclophosphamide in the body.

In clinical trials of people with rheumatoid arthritis (RA), receiving methotrexate or cyclophosphamide with Truxima didn’t change the level of rituximab-abbs (active drug in Truxima) in the body.

Truxima and other medications

Below is an example of a drug that can interact with Truxima. This section doesn’t cover all drugs that may interact with Truxima.

Before receiving Truxima, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Truxima and cisplatin

The use of Truxima and a chemotherapy drug called cisplatin can cause serious damage to the kidneys. You shouldn’t use these drugs together.

If you’re using cisplatin, talk with your doctor before you start treatment with Truxima. They can recommend different medication options.

Truxima and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Truxima. However, you should still check with your doctor or pharmacist before using any of these products while receiving Truxima.

Truxima and foods

There aren’t any foods that have been specifically reported to interact with Truxima. If you have any questions about eating certain foods with Truxima, talk with your doctor.

Truxima and vaccines

The use of Truxima with vaccines hasn’t been studied. However, Truxima may weaken your immune system (your body’s defense against infection). So it’s recommended that you avoid getting live virus vaccines before using Truxima and during your treatment.

Live virus vaccines contain a weakened form of the virus they’re meant to ward off. If your immune system is weak, your body may have a harder time fighting off the virus in the vaccine.

Some examples of live virus vaccines include:

Before starting your Truxima treatment, it’s recommended that you make sure you’re up to date with all your vaccinations. If you need any non-live vaccines, you should get them at least 4 weeks before you start using Truxima. Non-live vaccines don’t contain a live virus or bacterium.

Before you start using Truxima, talk with your doctor about any vaccines you received recently or if you’re due for any.

As with all medications, the cost of Truxima can vary. To find current prices for Truxima in your area, check out WellRx.com. The cost you find on WellRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan and your location.

Before approving coverage for Truxima, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Truxima, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Truxima, or if you need help understanding your insurance coverage, help is available.

Teva Pharmaceuticals USA, the manufacturer of Truxima, offers the Teva CORE program. For more information and to find out if you’re eligible for support, call 888-587-3263 or visit the program website for your condition below:

Truxima comes as a solution (liquid mixture) in a single-dose vial.

Truxima is given as an intravenous (IV) infusion. This is an injection into a vein in your arm that’s given over a period of time. A healthcare provider will give you Truxima infusions in a hospital, a clinic, or your doctor’s office.

Premedications

Your doctor will give you medications before each dose of Truxima to reduce your risk for having an infusion reaction. (See the “Truxima side effects” section above to learn more.)

You’ll likely receive a drug to reduce fever, such as acetaminophen (Tylenol). And to help prevent a rash and other allergy-like symptoms, you may be given an antihistamine medication like diphenhydramine (Benadryl).

And if you have rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA), you’ll also receive a steroid medication, such as methylprednisolone (Medrol) or a similar treatment.

How often Truxima is given

How often you receive your infusions depends on what condition you have and whether you receive chemotherapy with Truxima. See the “TruximaDosage” section above for more details.

To help make sure that you don’t miss an appointment, try setting a reminder on your phone. You can also write down your treatment schedule on a calendar.

Taking Truxima with food

You don’t have to eat while you’re receiving your infusions. But plan on bringing some snacks and water to your appointments. This is because you’ll be at the clinic, hospital, or doctor’s office for a good part of the day for your infusions.

Non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) are both types of cancer. NHL and CLL often start in a type of white blood cell called a B cell. With both types of cancer, B cells grow out of control.

Rheumatoid arthritis (RA) is a long-term autoimmune disease. With RA, your immune system mistakenly attacks the lining of your joints and may also affect other parts of the body like the heart and lungs. B cells normally help prevent your immune system from acting this way.

Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are conditions in which the immune system mistakenly attacks small blood vessels. This can result in narrowed blood vessels, making it harder for blood to flow through. B cells normally help prevent your immune system from acting this way.

For more details on what occurs with NHL, CLL, RA, GPA, and MPA, please see the “Truxima uses” section above.

What Truxima does

Truxima is an antibody (an immune system protein) that binds to another protein in your immune system called CD20. The CD20 protein is usually found on B cells.

Truxima works by binding to the CD20 protein and destroying B cells. This reduces the number of cancerous B cells that you have in your blood.

Truxima also destroys normal B cells, which are involved in the inflammation process. This may contribute to treating autoimmune and inflammatory diseases such as RA, GPA, and MPA. However, exactly how Truxima works isn’t completely understood.

How long does it take to work?

How fast Truxima works depends on the condition you’re being treated for and how severe it is.

Truxima may start working after your first infusion. However, it may take a few doses before you notice a decrease in your symptoms. For certain conditions, such as NHL and CLL, your doctor may order blood tests to check the levels of certain blood cells in your body to see if Truxima is working.

It’s not known if Truxima is safe to use during pregnancy. The drug has been shown to weaken the immune system in newborns of mothers who received Truxima while they were pregnant. The immune system is the body’s defense against infection.

If you’re pregnant or planning on becoming pregnant, talk with your doctor before starting Truxima treatment. They can advise you on the pros and cons of the medication.

It’s not known if Truxima is safe to use during pregnancy.

For women using Truxima

If you can become pregnant, you should use birth control while you’re using Truxima and for at least 12 months after you finish your treatment.

For men using Truxima

The manufacturer of Truxima hasn’t given any birth control recommendations for men who take the drug. However, if you’re a man who’s using Truxima and your sexual partner can become pregnant, talk with your doctor. They can review your birth control needs during and after your treatment.

For more information about using Truxima during pregnancy, see the “Truxima and pregnancy” section above.

You should avoid breastfeeding while using Truxima and for at least 6 months after your last dose.

There have been no studies of breastfeeding mothers who used Truxima. Studies in animals showed that Truxima can pass into breast milk. But what occurs in animal studies doesn’t always predict what will happen in humans.

If you’re breastfeeding or are planning to breastfeed, talk with your doctor before using Truxima. They can advise you on the best way to feed your child and what treatments are right for you.

Here are answers to some frequently asked questions about Truxima.

Is Truxima a chemotherapy drug?

No, Truxima isn’t a chemotherapy drug.

Truxima helps destroy specifically targeted cells in your body. Chemotherapy, on the other hand, attacks quickly growing cells, like cancer cells. Chemotherapy also affects other cells that aren’t cancer cells. So chemotherapy typically causes many more side effects than a targeted treatment.

Why does my doctor want me to take medication before my Truxima infusions?

Your doctor will give you medications before each dose of Truxima to reduce your risk for having an infusion reaction. (See the “Truxima side effects” section above to learn more.)

You’ll likely receive a drug to reduce fever, such as acetaminophen (Tylenol). And to help prevent a rash and other allergy-like symptoms, you may be given an antihistamine medication like diphenhydramine (Benadryl).

And if you have rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA), you’ll also receive a steroid medication, such as methylprednisolone (Medrol) or a similar treatment.

If you have any questions about medications you’ll need before your infusions, talk with your doctor.

Can I drive myself home after having an infusion of Truxima?

It’s best to arrange for someone else to drive you home. You may be tired after your infusion and from being in the clinic, hospital, or doctor’s office for most of the day.

Should I avoid getting any vaccines during Truxima treatment?

Yes. You should avoid getting live virus vaccines before using Truxima and during your treatment. These vaccines contain a weakened form of the virus they’re meant to ward off.

It’s not known how safe it is for you to receive live virus vaccines with Truxima. However, Truxima can weaken your immune system. And this may make it harder for your body to fight off the weakened virus in the vaccine.

Some examples of live virus vaccines include:

Before starting your Truxima treatment, it’s recommended that you make sure you’re up to date with all your vaccinations. If you need any non-live vaccines, you should get them at least 4 weeks before you start using Truxima. Non-live vaccines don’t contain a live virus or bacterium.

Before you start using Truxima, talk with your doctor about any vaccines you received recently or if you’re due for any.

This drug comes with several precautions.

FDA warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

  • Infusion-related reactions. Serious side effects can occur within the first 24 hours of receiving a Truxima infusion. (An infusion is an injection into your vein that’s given over a period of time.) These side effects include trouble breathing and chest pain, and some can be fatal. Your doctor will give you medication before your infusion to help reduce the risk of these reactions. They’ll also closely monitor you during and after your infusion. For more about infusion reactions, see the “Truxima side effects” section above.
  • Severe skin and mucous membrane reactions. Serious reactions in your skin and mucous membranes (tissues that protect parts of the body with mucus) can occur with Truxima. The reactions include the skin disorder Stevens-Johnson syndrome, and sometimes they can be fatal. While using Truxima, get medical help right away if you notice signs such as painful sores on your skin, lips, or inside your mouth. Your doctor will likely have you stop taking the drug. See the “Truxima side effects” section above for details.
  • Reactivation of hepatitis B virus. If you’ve had hepatitis B in the past or are a carrier of the hepatitis B virus (HBV), using Truxima may make the virus active. (A carrier is someone who has the virus but shows no symptoms.) This can lead to liver failure, and in some cases, death. Your doctor will check you for HBV before, during, and after your Truxima treatment. If you have HBV, your doctor may treat it before or while you receive Truxima. While using the medication, tell your doctor right away if you’re more tired than usual or if your skin or the white part of your eyes becomes yellow. These are possible symptoms of HBV reactivation.
  • Progressive multifocal leukoencephalopathy. Using Truxima when you have a weakened immune system can increase your risk for progressive multifocal leukoencephalopathy (PML). This is a rare brain infection caused by a virus. PML is a serious condition, and in some cases, it can lead to death. During your Truxima treatment, tell your doctor right away if you notice symptoms such as trouble walking or talking, or changes in your vision. They’ll likely have you stop using Truxima. Your doctor may also lower your dosage of other medications that weaken your immune system or have you stop taking them.

Other precautions

Before taking Truxima, talk with your doctor about your health history. Truxima may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Active infections. Truxima may weaken your immune system, making it harder for you to fight off infections. So your doctor will likely treat any active infections you have before you start using Truxima. “Active” means that you currently have symptoms. Talk with your doctor if you think you have an infection.
  • Kidney and heart problems. Truxima may cause kidney damage or heart problems (such as a heart attack) in some people. If you have a history of kidney or heart problems, talk with your doctor before starting Truxima treatment. They may recommend medications other than Truxima.
  • Pregnancy. It’s not known if Truxima is safe for pregnant women to use. For more information, please see the “Truxima and pregnancy” section above.
  • Breastfeeding. You should avoid breastfeeding while using Truxima and for at least 6 months after your last dose. For more information, please see the “Truxima and breastfeeding” section above.
  • Allergic reaction. If you’re allergic to Truxima or any of its ingredients, you shouldn’t use Truxima. Ask your doctor what other treatment options are better choices for you.

Note: For more information about the potential negative effects of Truxima, see the “Truxima side effects” section above.

The following information is provided for clinicians and other healthcare professionals.

Indications

Truxima is indicated to treat adults with:

  • CD20-positive B-cell non-Hodgkin lymphoma (NHL)
    • Use as a single agent in relapsed or refractory follicular or low-grade lymphoma.
    • Combine with chemotherapy in treatment-naïve patients with low-grade or follicular lymphoma. If patients have a complete or partial response, continue as maintenance therapy.
    • Use as a maintenance therapy after chemotherapy with cyclophosphamide, vincristine, and prednisone (Rayos) (CVP) in non-progressing (including stable disease), low-grade NHL.
    • Use in treatment-naïve diffuse large B-cell lymphoma as a combination therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or other anthracycline-based (CHOP-like) chemotherapy.
  • CD20-positive chronic lymphocytic leukemia (CLL)
    • Use in combination with fludarabine and cyclophosphamide in previously treated and untreated CLL.
  • moderately to severely active rheumatoid arthritis (RA) that has had an insufficient response to at least one TNF antagonist therapy; used with methotrexate (Trexall)
  • granulomatosis with polyangiitis (GPA) when used with glucocorticoids
  • microscopic polyangiitis (MPA) when used with glucocorticoids

Administration

Truxima is given as an intravenous (IV) infusion by a healthcare professional. It is infused over the course of at least 90 minutes if the first infusion is tolerated. The infusion times are often longer depending on the patient’s height and weight, other treatments, and past history of infusion reactions.

Truxima should never be given as an IV push or bolus. Truxima should be administered only in a hospital, a clinic, or an office where staff can provide emergency treatment to manage severe infusion reactions.

Premedication with acetaminophen (Tylenol) and diphenhydramine (Benadryl) should be administered prior to each infusion to help minimize infusion-related reactions. For patients receiving Truxima over 90 minutes, administer the glucocorticoid part of their chemotherapy prior to the infusion.

Patients with RA, GPA, or MPA should also receive methylprednisolone (Medrol) or similar therapy 30 minutes before each Truxima infusion.

Refer to the Truxima prescribing information for more details on premedication recommendations.

Mechanism of action

Truxima is a monoclonal antibody that specifically targets CD20, an antigen that is found on the surface of B lymphocytes.

Truxima works by binding to CD20 on B lymphocytes and is believed to destroy the B cells via cell lysis pathways such as:

  • complement-dependent cytotoxicity
  • antibody-dependent cell-mediated cytotoxicity

B cells may be involved with inflammatory pathways that cause RA or other autoimmune and inflammatory diseases. Destroying B cells could have a role in reducing inflammation and other symptoms in these diseases.

Pharmacokinetics and metabolism

The type of cancer Truxima treats affects the pharmacokinetics. In patients taking Truxima for NHL, the half-life of the drug is 22 days, while the half-life is 32 days in patients taking Truxima for CLL.

Contraindications

There are no contraindications to Truxima.

Storage

Store Truxima vials in a refrigerator between 36°F to 46°F (2°C to 8°C) and protect from light. Do not shake or freeze. Discard the vial after use.

Truxima should be diluted with 0.9% sodium chloride or 5% dextrose injection to a final concentration of 1 to 4 mg/mL. The diluted mixture may be stored in the refrigerator between 36°F to 46°F (2°C and 8°C) for 24 hours. The solution is stable at room temperature for another 24 hours. However, it is recommended to keep the diluted solution in a refrigerator because Truxima is preservative-free.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.