Jonathan Edwards
"Gibberish"
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That's interesting - I didn't know that drug doses were calculated by initial testing. I had thought doses were calculated in relation to weight only. So the Rituximab dose formula isn't based on testing of Rituximab itself?
Nobody knows what the right dose of rituximab is. The original dose recommendation of 375mg/metre squared x 4 doses was based on just how much drug they had in the fridge when they did the pilot study. Over a period of twenty years various bits of evidence have suggested that the dose we use for autoimmunity is roughly right but it is not well established. The current trend for giving two doses for induction is really just based on how much drug you can reasonably give in a day. The spacing apart of two weeks is an artefact of my pilot trial with cyclophosphamide that people have stuck with because they do not know where it comes from.
BUT, the one thing I would say is that Drs Fluge and Mella are developing the longer term treatment schedule in an extremely intelligent and imaginative way. They are watching exactly what is happening as they go along and adjusting accordingly. It might be possible to get away with a much smaller initial dose but I suspect their follow up doses are pretty much right.