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Rituximab
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==Risks & side effects== Rituximab is given by infusion in a hospital. Unwanted effects are not common but can be serious. Allergic reactions can normally be avoided by careful monitoring while giving the infusion very slowly at first. Sterile pneumonia-like episodes can occur within a few days after infusions. Susceptibility to infection may be increased if there are other reasons for being at risk but in general immunosuppression is not a major problem. <ref>{{Cite web|url=https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/rituximab | title = Rituximab (Mabthera) {{!}} Cancer information | last = | first = | authorlink = | date = | website=Cancer Research UK|archive-url=|archive-date=|url-status=|access-date=2021-11-21}}</ref> Rarely, the temporary immunosuppression caused from Rituximab may cause a reactivation of a persistent enteroviral infection with potentially dangerous central nervous system complications.<ref name="Rhoades2011">{{Cite journal | last = Rhoades | first = Ross E. | last2 = Tabor-Godwin | first2 = Jenna M. | last3 = Tsueng | first3 = Ginger | last4 = Feuer | first4 = Ralph | date = 2011-03-15 | title = Enterovirus infections of the central nervous system|url=https://www.sciencedirect.com/science/article/pii/S0042682210007683|journal=Virology|series=Special Reviews Issue 2011|language=en|volume=411|issue=2|pages=288β305|doi=10.1016/j.virol.2010.12.014|issn=0042-6822}}</ref> Another rare but usually fatal viral disease triggered in a weakened immune system during the use of Rituximab is Progressive Multifocal Leukoencephalopathy (PML), caused by the the human polyomavirus John Cunningham virus (JCV). PML is being researched by Dr. [[Eugene Major]], a member of the [[NIH Post-Infectious ME/CFS Study]]. <ref>{{Cite journal|title=Progressive Multifocal Leukoencephalopathy in Patients on Immunomodulatory Therapies|date=2010-02-01|url=https://www.annualreviews.org/doi/10.1146/annurev.med.080708.082655|journal=Annual Review of Medicine|volume=61|issue=1|pages=35β47|last=Major|first=Eugene O.|language=en|doi=10.1146/annurev.med.080708.082655|issn=0066-4219}}</ref> Rituximab was reportedly being offered to ME/CFS patients in the United States ([[Andreas Kogelnik]] at the [http://www.openmedicineinstitute.org/the-clinic.html Open Medicine Institute]) and in Norway (a private clinic in Sandnes)<ref name="SandnesNO" /> but experts such as [[Jonathan Edwards]] has advised against this, stating in 2015 "As the person who established that rituximab is useful in autoimmune disease I would actually advise against this. Rituximab is very unlike most drugs in that you have to understand how to use it in considerable detail in order to give it safely and effectively".<ref>[http://forums.phoenixrising.me/index.php?threads/is-there-any-way-i-can-be-treated-with-rituximab-privately.39972/ Phoenix Rising - Is there any way I can be treated with rituximab privately?]</ref><ref>[http://forums.phoenixrising.me/index.php?threads/de-meirleir-is-using-rituximab.44442/#post-722413 Phoenix Rising - De Meirleir is using Rituximab?]</ref> The British patient charity the [[ME Association]] has also advised against patients looking for treatment with the drug outside of clinical trials.<ref>{{Cite web|url=https://meassociation.org.uk/2016/05/rituximab-update-by-the-me-association-23-may-2016/ | title = Rituximab β update by The ME Association {{!}} 23 May 2016 | last = | first = | authorlink = | date = 2016-05-23 | website = [[ME Association]]|language=en-GB|archive-url=|archive-date=|url-status=|access-date=2021-11-21}}</ref> In the RituxME trial, a higher percentage of serious adverse events with possible or probable relation to the intervention was noted in the rituximab group.<ref name="phase3-2019" />
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