Barriers to Rituximab therapy in Pakistan

rituximab in Pakistan

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
    • Lymphoma
    • Waldenstrom’s macroglobulinemia
  • Autoimmune rheumatic diseases:

A complete list of Rituximab indications can be viewed @

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.

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