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Briefing note: rituximab subcutaneous (Mabthera)

What is rituximab used for?

Rituximab is a treatment for non-Hodgkin’s lymphoma (NHL), a type of cancer of the lymphatic system (part of the body’s immune defence against infection). There are many different types of NHL, often grouped as B-cell or T-cell depending on the cells of the body in which they began. B-cell lymphomas are more common, and follicular lymphoma is a common type of B-cell cancer.

How does it work?

Rituximab is a type of medicine called a monoclonal antibody. It works by targeting and removing cells of the immune system that do not work properly. It is given as an injection under the skin over approximately 5 minutes.

What has SMC advised?

SMC accepted rituximab for restricted use in NHL in adults:

  • in previously untreated patients with stage III-V follicular lymphoma in combination with chemotherapy
  • maintenance therapy is indicated for the treatment of follicular lymphoma patients responding to induction therapy
  • treatment of patients with CD20 positive diffuse large B cell - non-Hodgkin’s lymphoma in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) chemotherapy.

Subcutaneous rituximab is accepted for use in line with previous SMC advice for intravenous rituximab (that is, accepted within licensed indication as above except for patients receiving maintenance treatment, where use is restricted to patients who have responded to induction therapy with rituximab plus chemotherapy).

What is the evidence for this?

  • Studies have shown that the effects on the body of this formulation of rituximab are similar to those when the medicine is given into a vein as an infusion. This new formulation offers advantages to the patient and service in terms of reducing the time taken to give the medicine to approximately 5 minutes.
  • This SMC advice takes account of the benefits of a patient access scheme (PAS).  A PAS is a scheme proposed by a pharmaceutical company in order to improve the cost effectiveness of a medicine and thus enable patients to receive access to new medicines that may otherwise not have been judged to be a cost-effective use of NHS resources. The proposed PAS gives a discount on the price of the medicine.
  • An economic analysis compared this formulation of rituximab with the intravenous formulation. It showed that this formulation could lead to cost savings when the PAS was taken into account.

SMC accepted rituximab subcutaneous injection for use because the balance of costs and benefits meant that it was considered to offer value for money when the PAS was taken into account. This SMC advice depends upon the continuing availability of the PAS or an equivalent or lower list price in NHSScotland.