Course of neuromyelitis optica during inadvertent pregnancy in a patient treated with rituximab

Abstract

In neuromyelitis optica (NMO), the monoclonal B-cell antibody rituximab is a therapeutic option. Little is known about the course of NMO and the safety of rituximab during pregnancy. In this study, we report the clinical course of a patient with NMO after application of rituximab 1 week before inadvertent conception. Mother and child did not experience any adverse event, and the postpartum development of the baby was completely normal up to 15 months. Clinical course of NMO was stable during the entire pregnancy. This case illustrates a favorable outcome in a pregnant NMO patient and her child after therapy with rituximab. Multiple Sclerosis 2009; 15: 1006-1008.

Neuromyelitis optica and pregnancy during therapeutic B cell depletion: infant exposure to anti-AQP4 antibody and prevention of rebound relapses with low-dose rituximab postpartum

“…The mother was clinically stable during pregnancy, but had not been treated upon delivery and experienced two severe relapses 10 days and two months thereafter. 7 In our patient, the correlation between anti-AQP4 antibody titers and clinical disease activity, as previously observed, 11 as well as the relation between rituximab administration and anti-AQP4 antibody, remained ambiguous. Rituximab may disrupt T-B lymphocyte interactions, which is beneficial in MS and NMO, while we were not able to establish a solid correlation between anti-AQP4 antibody titers, clinical relapses and drug application.…”

“…These findings support previous experiences with an NMO patient with inadvertent conception one week after application of high-dose rituximab (1000 mg twice within two weeks). 7 In that report, the child developed normally during follow-up for 15 months after birth. The mother was clinically stable during pregnancy, but had not been treated upon delivery and experienced two severe relapses 10 days and two months thereafter.…”

“…5,6 Recently, the clinical course of NMO in a pregnant woman who received rituximab shortly before conception and experienced two relapses 10 days and two months after delivery has been described. 7 Here, we report the case of an NMO patient who became pregnant following low-dose rituximab and remained stable by early postpartum rituximab treatment.…”

Are biological drugs safe in pregnancy?

“…In this respect the London Position Statement of the World Congress of Gastroenterology on the Biological Therapy for IBD stated that vaccination of infants exposed to biological therapy in utero should be given according standard schedules, except for live-virus vaccines, which are not recommended if biological agents are detectable in the infant bloodstream (71). Table III summaries the reports of maternal exposure to rituximab either prior to or during pregnancy (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Rituximab has various indications.…”

Relevance of Autoantibodies for the Classification and Pathogenesis of Neurological Diseases

“…Furthermore, 12 pedigrees of NMO patients with a total number of 25 patients were recently analyzed by Mattiello and his group, resulting in 3% familial NMO cases in patients with clinical definite NMO (Matiello et al, 2010). This number might be larger when also including patients with high risk NMO, as the disease can have a heterogeneous presentation (Pellkofer et al, 2009). …”