Front Desk: 469-391-0070
B Cell Depleting Agents: How They Work in Autoimmune Therapy
Introduction: Key Points on B Cell Depleting Agents
B cell depleting agents are medications used to treat autoimmune diseases and certain cancers by targeting and reducing B cells in the body. B cells, a type of white blood cell, play a role in inflammation and disease progression. These medications are often prescribed when other treatments have not been effective. Speak with one of our telemedicine providers to determine if B cell therapy is the right option for you.
Medications in the B Cell Depleting Agents Class
Here are some commonly prescribed B cell depleting agents:
- Arzerra (Ofatumumab)
- Benlysta (Belimumab)
- Rituxan (Rituximab)
- Tepezza (Teprotumumab)
- Venclexta (Venetoclax)
The generic name, listed in parentheses, refers to the active ingredient in each drug.
How B Cell Depleting Agents Work: Mechanism of Action
B cell depleting agents work by reducing the number of B cells in the body. B cells are essential to the immune system, particularly in producing antibodies. In autoimmune diseases, B cells can mistakenly attack the body’s own tissues, leading to inflammation and damage. By lowering B cell levels, these medications help reduce inflammation and slow the progression of the disease.
Different medications in this class may target B cells in slightly different ways. For example, Rituximab (Rituxan) binds to a protein called CD20 on B cells, leading to their destruction. Ofatumumab (Arzerra) also targets CD20 but binds to a different part of the protein, which may make it more effective in certain situations. Belimumab (Benlysta) works by blocking a protein called BLyS, which helps B cells survive. By inhibiting BLyS, Belimumab reduces the number of circulating B cells.
Benefits of B Cell Therapy
B cell depleting agents are often used when other treatments have not been successful, particularly in autoimmune diseases like rheumatoid arthritis, lupus, and cancers such as chronic lymphocytic leukemia (CLL). These medications are favored in some cases because they specifically target B cells, which play a central role in these conditions. By reducing B cell activity, these treatments help control symptoms, decrease inflammation, and slow the progression of the disease.
In autoimmune disease management, B cell depleting agents may be considered when patients do not respond well to traditional treatments like corticosteroids or disease-modifying antirheumatic drugs (DMARDs). In cancers like CLL, these medications can reduce the number of cancerous B cells, potentially leading to remission or slowing the disease’s advancement.
If you are considering B cell therapy, it’s important to discuss your options with a healthcare provider. Our telemedicine providers are available to help you determine if this treatment is appropriate for your condition.
Potential Side Effects of B Cell Depleting Agents
Like all medications, B cell depleting agents can cause side effects. It’s important to be aware of these potential reactions so you can monitor your health and discuss any concerns with your healthcare provider. Below is a list of common and less common side effects. If you experience any severe side effects, contact your doctor immediately. You can also schedule a telemedicine appointment with one of our providers for guidance.
Common Side Effects (Greater than 1%)
- Infusion-related reactions (up to 40%): These reactions typically occur during or shortly after the infusion. Symptoms may include fever, chills, nausea, rash, and headache. Patients with a history of allergic reactions or asthma may be at higher risk.
- Infections (up to 30%): B cell depleting agents can weaken your immune system, increasing your susceptibility to infections, including upper respiratory and urinary tract infections. Patients with recurrent infections or immune-compromising conditions are at higher risk.
- Fatigue (up to 20%): Many patients report feeling unusually tired after starting treatment. While this may improve over time, it can persist in some cases.
- Low white blood cell count (up to 10%): These medications can reduce white blood cells, which are crucial for fighting infections. Your doctor may monitor your blood counts regularly to ensure they remain within a safe range.
- Headache (up to 10%): Headaches can occur, particularly after infusion. These are usually mild and temporary but should be reported if they persist.
Less Common Side Effects (Less than 1%)
Other less frequent side effects include:
- Severe allergic reactions (anaphylaxis)
- Reactivation of hepatitis B
- Progressive multifocal leukoencephalopathy (PML)
- Heart problems, such as arrhythmias
- Low platelet count
- Severe skin reactions
- Hypotension (low blood pressure)
- Shortness of breath
- Diarrhea
- Muscle pain
If you experience any of these side effects, especially severe ones, speak with your healthcare provider immediately. Serious reactions like anaphylaxis or PML require urgent medical attention. You can also schedule a telemedicine visit with one of our providers to discuss your symptoms and receive appropriate care.
Drug to Drug Interactions with B Cell Depleting Agents
B cell depleting agents can interact with other medications, potentially increasing side effects or reducing the effectiveness of your treatment. It’s essential to inform your doctor about all the medications you are taking, including over-the-counter drugs, supplements, and herbal products. Below are some common drug interactions to be mindful of when undergoing B cell therapy:
Immunosuppressive drugs: Combining B cell depleting agents with other immunosuppressants (such as methotrexate or corticosteroids) can increase the risk of infections.
Live vaccines: Live vaccines (e.g., MMR, varicella) should be avoided during treatment, as B cell depleting agents can weaken your immune response, making vaccines less effective and raising the risk of infection.
Antihypertensive medications: Some B cell depleting agents may lower blood pressure. When combined with blood pressure-lowering medications, this could increase the risk of hypotension (low blood pressure).
Anticoagulants: If you are taking blood thinners (such as warfarin), there may be an increased risk of bleeding, especially if your platelet count is affected by the B cell depleting agent.
Always inform your healthcare provider about all medications before starting a B cell depleting agent. If you have concerns about potential drug interactions, consider scheduling a telemedicine appointment with one of our providers for personalized advice.
Precautions and Contraindications for B Cell Therapy
Before beginning treatment with a B cell depleting agent, certain precautions and contraindications should be carefully considered. These factors can help determine whether this medication is safe and appropriate for you.
Precautions to Take Before B Cell Therapy
Infection risk: Since B cell depleting agents can weaken your immune system, it’s important to avoid contact with individuals who have infections. Your doctor may recommend screening for infections like hepatitis B and tuberculosis before starting treatment.
Vaccination: Complete any necessary vaccinations before starting a B cell depleting agent, as live vaccines are contraindicated during treatment. Non-live vaccines may also be less effective while on this therapy.
Pregnancy and breastfeeding: B cell depleting agents are generally not recommended during pregnancy or breastfeeding due to potential risks to the baby. If you are pregnant, planning to become pregnant, or breastfeeding, discuss your options with your doctor.
Pre-existing conditions: If you have a history of heart disease, kidney problems, or other chronic conditions, your doctor may need to monitor you more closely during treatment to ensure your safety.
Contraindications for B Cell Depleting Agents
Severe active infections: If you have an active infection, treatment with a B cell depleting agent should be postponed until the infection is fully resolved.
Allergy to the medication: If you have experienced a severe allergic reaction to a B cell depleting agent in the past, you should not use this medication again.
Severe immunosuppression: Patients with severely compromised immune systems may not be suitable candidates for B cell depleting agents due to the heightened risk of life-threatening infections.
If you have any of these conditions or concerns, it’s important to discuss them with your healthcare provider before starting treatment. You can also schedule a telemedicine consultation with one of our providers to review your medical history and determine if this medication is right for you.
Conclusion: Managing B Cell Depleting Agents for Optimal Health
B cell depleting agents are a powerful treatment option for various autoimmune diseases and certain cancers. While they can be highly effective, they also come with potential side effects and risks that require careful management. It’s essential to work closely with your healthcare provider to monitor your health during treatment and address any concerns that may arise. If you’re considering starting a B cell depleting agent or have questions about your current treatment, schedule a telemedicine appointment with one of our providers today. We are here to help you make informed decisions about your health and ensure you receive the best possible care.
