Active Substance: rituximab
Common Name: rituximab
ATC Code: L01XC02
Marketing Authorisation Holder: Sandoz GmbH
Active Substance: rituximab
Authorisation Date: 2017-06-15
Therapeutic Area: Wegener Granulomatosis Microscopic Polyangiitis Arthritis, Rheumatoid Lymphoma, Non-Hodgkin
Pharmacotherapeutic Group: Antineoplastic agents
Riximyo is indicated in adults for the following indications:
Non-Hodgkin’s lymphoma (NHL)
Riximyo is indicated for the treatment of previously untreated patients with stage III-IV follicular lymphoma in combination with chemotherapy.
Riximyo maintenance therapy is indicated for the treatment of follicular lymphoma patients responding to induction therapy.
Riximyo monotherapy is indicated for treatment of patients with stage III-IV follicular lymphoma who are chemoresistant or are in their second or subsequent relapse after chemotherapy.
Riximyo is indicated for the treatment of patients with CD20 positive diffuse large B cell non Hodgkin’s lymphoma in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) chemotherapy.
Riximyo in combination with methotrexate is indicated for the treatment of adult patients with severe active rheumatoid arthritis who have had an inadequate response or intolerance to other disease modifying anti-rheumatic drugs (DMARD) including one or more tumour necrosis factor (TNF) inhibitor therapies.
Rituximab has been shown to reduce the rate of progression of joint damage as measured by X-ray and to improve physical function, when given in combination with methotrexate.
Granulomatosis with polyangiitis and microscopic polyangiitis
Riximyo, in combination with glucocorticoids, is indicated for the induction of remission in adult patients with severe, active granulomatosis with polyangiitis (Wegener’s) (GPA) and microscopic polyangiitis (MPA).
What is Riximyo and what is it used for?
Riximyo is a medicine used in adults to treat the following blood cancers and inflammatory conditions:
- follicular lymphoma and diffuse large B cell non-Hodgkin’s lymphoma (two types of non-Hodgkin’s lymphoma, a blood cancer);
- severe rheumatoid arthritis (an inflammatory condition of the joints);
- granulomatosis with polyangiitis (GPA or Wegener’s granulomatosis) and microscopic polyangiitis (MPA), which are inflammatory conditions of the blood vessels.
Depending on the condition it is used to treat, Riximyo may be given on its own, or with chemotherapy (other cancer medicines) or medicines used for inflammatory disorders (methotrexate or a corticosteroid). Riximyo contains the active substance rituximab.
Riximyo is a ‘biosimilar medicine’. This means that Riximyo is highly similar to a biological medicine (also known as the ‘reference medicine’) that is already authorised in the European Union (EU). The reference medicine for Riximyo is MabThera.
How is Riximyo used?
Riximyo can only be obtained with a prescription. It is available as a concentrate for making a solution that must be given by infusion (drip) into a vein. Before each infusion, the patient should be given an antihistamine (to prevent allergic reactions) and an anti-pyretic (a medicine to reduce fever). The medicine should be given under the close supervision of an experienced healthcare professional and in a place where facilities for resuscitating patients are immediately available.
For further information, see the package leaflet.
How does Riximyo work?
The active substance in Riximyo, rituximab, is a monoclonal antibody (a type of protein) designed to recognise and attach to a protein called CD20 present on the surface of B cells (types of white blood cells). When rituximab attaches to CD20, it causes the death of B cells, which helps in lymphoma (where B cells have become cancerous) and in rheumatoid arthritis (where B cells are involved in joint inflammation). In GPA and MPA, destroying the B cells lowers the production of antibodies thought to play an important role in attacking the blood vessels and causing inflammation.
What benefits of Riximyo have been shown in studies?
Laboratory studies comparing Riximyo with MabThera have shown that the active substance in Riximyo is highly similar to that in MabThera in terms of structure, purity and biological activity.
Because Riximyo is a biosimilar medicine, the studies on effectiveness and safety of rituximab carried out with MabThera do not all need to be repeated for Riximyo. Studies were carried out to show that giving Riximyo produces similar levels of the active substance in the body to giving MabThera.
Riximyo was also shown to be as effective as MabThera in one main study involving 629 patients with advanced, untreated follicular lymphoma, where Riximyo or MabThera were added to other chemotherapy for part of the treatment. The cancer responded to treatment in 87% of those given Riximyo (271 of 311 patients), and in similar numbers of those given MabThera (274 of 313 patients). A supportive study in patients with rheumatoid arthritis also indicated similar effectiveness between MabThera and Riximyo.
What are the risks associated with Riximyo?
The most common side effects with rituximab are reactions related to the infusion (such as fever, chills and shivering) which occur in the majority of cancer patients and about a quarter of rheumatoid arthritis patients at the time of the first infusion. The risk of such reactions decreases in subsequent infusions. The most common serious side effects are infusion reactions, infections and, in cancer patients, heart-related problems. Other serious side effects include hepatitis B reactivation (return of previous active liver infection with hepatitis B virus) and a rare and severe brain infection known as progressive multifocal leukoencephalopathy (PML). For the full list of side effects reported with Riximyo, see the package leaflet.
Riximyo must not be used in people who are hypersensitive (allergic) to rituximab, mouse proteins or any of the other ingredients. It must also not be used in patients with a severe infection or a severely weakened immune system. Patients with rheumatoid arthritis, GPA or MPA must also not receive Riximyo if they have severe heart problems.
Why is Riximyo approved?
The Agency’s Committee for Medicinal Products for Human Use (CHMP) decided that, in accordance with EU requirements for biosimilar medicines, Riximyo has a highly similar structure, purity and biological activity to MabThera and is distributed in the body in the same way. In addition, a study comparing Riximyo to MabThera in patients with follicular lymphoma showed that both medicines are similarly effective. Thus, all these data were considered sufficient to conclude that Riximyo will behave in the same way in terms of effectiveness as MabThera in its approved indications. Therefore, the CHMP’s view was that, as for MabThera, the benefit outweighs the identified risk. The Committee recommended that Riximyo be given marketing authorisation.
What measures are being taken to ensure the safe and effective use of Riximyo?
The company that markets Riximyo will provide doctors and patients using the medicine for non-cancer conditions with educational material including information on the need to give the medicine where facilities for resuscitation are available, and on the risk of infection, including PML. Patients are also to receive an alert card, which they are to carry at all times, instructing them to contact their doctor immediately if they have any of the listed symptoms of infection.
Doctors prescribing Riximyo for cancer will be provided with educational material reminding them of the need to use the medicine only by infusion into a vein.
Recommendations and precautions to be followed by healthcare professionals and patients for the safe and effective use of Riximyo have also been included in the summary of product characteristics and the package leaflet.
Other information about Riximyo
The European Commission granted a marketing authorisation valid throughout the European Union for Riximyo on 17 June 2017.
For more information about treatment with Riximyo, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.