Rituximab is available in Pakistan by the brand names of Ristova and MabThera (Roche Pakistan Ltd).
It is indicated for a variety of conditions worldwide. Some of the common indications of Rituximab are:
- Blood cancers:
- Chronic Lymphocytic Leukemia
- Waldenstrom’s macroglobulinemia
- Autoimmune rheumatic diseases:
- Rheumatoid Arthritis
- Wegener’s Granulomatosis
- Microscopic polyangiitis
- Immune thrombocytopenia
- Autoimmune hemolytic anemia
- Refractory Lupus Nephritis
- Myasthenia gravis
- Pemphigus vulgaris
- Graft versus host disease
A complete list of Rituximab indications can be viewed @ emedz.net
There is a long list of indications, however, rituximab is rarely used to treat these disorders in Pakistan.
I have compiled just a few of the barriers to its use. To add more to the list, leave a comment below.
List of barriers to the use of Rituximab in Pakistan:
Rituximab is too costly:
- Probably, this is the among the top barriers to its use. I have seen most patients with the above mentioned chronic diseases in Pakistan are getting treatment through the Baitulmaal (Social Welfare funds) and zakat funds.
- Patients can not even afford the conventional therapies. Most of them even cannot afford to get the tests done. Flowcytometry and the immune markers are also very costly.
- Patients who need intensive and high dependency care start taking loans.
I have seen the attendants of the patients skipping meals to save money, get the tests done, and buy the medications.
- Our doctors raise funds (among the doctors’ community) almost on a daily basis but that is way too less.
Most doctors are reluctant to start immunotherapy because of lack of experience:
- Since very few centers in Pakistan treat their patients with the biologics, most physicians lack the experience.
- Therapy with the Biologics requires pretreatment evaluation, dose calculations, monitoring during treatment, and post-treatment regular assessments for complications.
The use of Biologics is associated with serious infections:
- Rituximab use is associated with the incidence of serious infections. These include fatal bacterial and fungal infections and serious viral infections like CMV infections, Herpes, Varicella, and ParvoVirus infections.
- Reactivation of Tuberculosis and Hepatitis B infection is very common and all patients need to be screened for these infections prior to the therapy.
- Since Tuberculosis is very common in Pakistan, latent TB is not uncommon. This results in reactivation of Tuberculosis that may lead to the progression of the primary disease.
Backup support is not available to deal with the complications:
- Rituximab therapy may sometimes result in severe anaphylactic reactions that may require intensive care support.
- Cardiovascular complications include fatal arrhythmias, myocardial infarction, and cardiogenic shock.
- Serious anaphylactic reactions include anaphylaxis, angioedema, and acute respiratory distress syndrome.
- Other adverse reactions include liver and renal toxicity that may at times require dialysis support.
- Backup support including dialysis support and intensive care support is lacking, limiting the use of rituximab therapy.
Click here for Detailed Indications, Contraindications, Dosages, and Side effects.
tadalafil 20 mg https://skuvsbs.gonevis.com/when-tadalafil-5mg-competitors-is-good/
Wonderful stuff. With thanks!
cialis pills https://hemuyrt.livejournal.com/325.html
Really many of excellent advice!
tadalafil without a doctor’s prescription https://site373681070.fo.team/
Cheers, Awesome information!
cialis 20mg https://sehytv.wordpress.com/
Wow quite a lot of amazing knowledge.
cialis 5mg https://ghswed.wordpress.com/2022/04/27/he-final-word-information-to-online-pharmacies/
Tips clearly used!.
cialis tablets australia https://kerbgsw.mystrikingly.com/
You said it perfectly..
Generic cialis tadalafil https://kuebser.estranky.sk/clanky/supereasy-methods-to-study-every-part-about-online-medicine-order-discount.html
Thanks, Ample tips.
canadian pharmacy world https://kewertyn.wordpress.com/2022/04/27/expect-more-virtual-house-calls-out-of-your-doctor-thanks-to-telehealth-revolution/
You actually expressed this really well!
Good content. Thank you!
tadalafil 20mg https://heswcxc.wordpress.com/2022/04/30/online-medicine-tablets-shopping-promotion-one-hundred-and-one/
Whoa loads of terrific advice.
canada pharmacy https://sernert.estranky.sk/clanky/confidential-information-on-online-pharmacies.html
You said it nicely..
canadian pharmacy online 24 https://kertubs.mystrikingly.com/
Thank you, I value this.
canadian pharmacy online 24 https://626f977eb31c9.site123.me/blog/how-google-is-changing-how-we-approach-online-order-medicine-1
This is nicely said. .
cialis 20mg prix en pharmacie https://canadian-pharmaceuticals-online.yolasite.com/
You actually revealed this adequately.
canadian prescription drugstore https://online-pharmacies0.yolasite.com/
Very good knowledge. Thank you!
cialis uk https://6270e49a4db60.site123.me/blog/the-untold-secret-to-mastering-aspirin-in-just-7-days-1
Nicely put. Thank you!
tadalafil 20 mg https://deiun.flazio.com/
Truly quite a lot of fantastic advice!
cialis online https://kertyun.flazio.com/
You reported it really well!
cialis from canada https://kerntyas.gonevis.com/the-mafia-guide-to-online-pharmacies/
Useful info. Appreciate it!
cialis 20 mg best price https://kerbnt.flazio.com/
Nicely put, Appreciate it.
Cheap cialis http://nanos.jp/jmp?url=http://cialisonlinei.com/
Many thanks. Terrific stuff!
online pharmacy http://ime.nu/cialisonlinei.com
Terrific info. Regards.
online cialis https://womed7.wixsite.com/pharmacy-online/post/new-ideas-into-canada-pharmacies-never-before-revealed
You actually explained that fantastically!
online cialis https://kerntyast.flazio.com/
You actually revealed that well!
canadian drug https://sekyuna.gonevis.com/three-step-guidelines-for-online-pharmacies/
This is nicely expressed! .
online prescriptions without a doctor https://gewrt.usluga.me/
You said it adequately..
canada drug pharmacy https://pharmacy-online.webflow.io/
Reliable forum posts. Thanks.
canadian pharmacies shipping to usa https://canadian-pharmacy.webflow.io/
Position certainly utilized..
cialis 20 mg best price https://site273035107.fo.team/
You mentioned this fantastically.
cialis online https://site656670376.fo.team/
You’ve made the point.
canadian pharmacy https://site561571227.fo.team/
Thanks. Valuable stuff!
cialis lowest price https://site102906154.fo.team/
Thanks a lot! Lots of stuff!
canadian pharmacy king https://hekluy.ucraft.site/
Terrific tips. Regards!
cialis purchase online without prescription https://kawsear.fwscheckout.com/
Valuable advice. Thanks!
buy viagra 25mg https://hertnsd.nethouse.ru/
You actually expressed it effectively!
online cialis https://uertbx.livejournal.com/402.html
Incredible a good deal of very good info.
cialis generico online https://lwerts.livejournal.com/276.html
Awesome information. Thanks a lot.
generic for cialis https://avuiom.sellfy.store/
Incredible a lot of awesome info!
cialis tablets australia https://pharmacies.bigcartel.com/
You explained it well.
tadalafil tablets https://kwersd.mystrikingly.com/
With thanks! A lot of forum posts!
tadalafil 20mg https://gewsd.estranky.sk/clanky/drugstore-online.html
Regards. I like this.
This is nicely said! !
cialis canada http://site592154748.fo.team/
Truly loads of fantastic data.
You said this exceptionally well.
Canadian Pharmacy USA http://aonubs.website2.me/
Awesome forum posts, Cheers!
cialis canadian pharmacy https://dkyubn.bizwebs.com/
Regards, Numerous content.
cialis 20 mg best price https://asebg.bigcartel.com/canadian-pharmacy
Thanks! Fantastic stuff!
canadian cialis https://medicine-online.estranky.sk/clanky/understand-covid-19-and-know-the-tricks-to-avoid-it-from-spreading—–medical-services.html
Thanks a lot! I appreciate it.
buy cialis https://kertvbs.webgarden.com/
Regards, An abundance of data.
buy cialis online https://disvaiza.mystrikingly.com/
Beneficial knowledge. Thanks!