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What is your approach to timing of medications like Rituximab and Cyclophosphamide around plasmapheresis in patients on daily PLEX?
Answer from: at Community Practice
Plasma exchange (PLEX) in designed to remove antibodies. Thus, PLEX will remove monoclonal antibodies, including rituximab, and do so fairly effectively and likely to some extent in proportion to the intensity of the PLEX. If there is a clinical need to use PLEX for a patient also to be given rituxi...
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Answer from: at Academic Institution
Agree. Cyclophosphamide is inactive as administered and metabolized to multiple active compounds with differing effects and a half lives, none of which can we reliably measured. Hence, the effect of renal insufficiency is not well understood. An empiric measure of the effect that has been employed i...
Answer from: at Community Practice
The pharmacokinetics of cyclophosphamide in patients with renal impairment is not well studied; thus, the dosing in such a situation is not standardized. However, some general guidelines have been incorporated into clinical trials for the treatment of patients with ANCA-associated vasculitis. These ...
Answer from: at Academic Institution
Thank you for the wonderful response, @Peter A. Merkel.
Agree with timing of cyclophosphamide after hemodialysis. Do you have any thoughts on how to administer cyclophosphamide on patients on continuous renal replacement, such as CRRT (have heard varied opinions: wait until after CRRT or that given...