Rituximab before and during pregnancy

Abstract

ObjectiveTo evaluate the safety of rituximab treatment before and during pregnancy in women with MS and neuromyelitis optica spectrum disorders (NMOSDs) who may be at risk of relapses by performing a systematic literature review combined with a retrospective single-center case series.MethodsStudies were systematically identified in the PubMed, Google Scholar, and EMBASE using the key terms “pregnancy” and “rituximab”; 22 articles were included for review (>17,000 screened). Then, patients with MS and NMOSD from 1 center (University of California, San Francisco) exposed to rituximab before conception were identified through medical record review.ResultsSystematic review: We identified 102 pregnancies with rituximab use within 6 months of conception: 78 resulted in live births and 12 in spontaneous abortions. Of 54 live births with reported gestational age, 31 occurred at term (37 weeks+) and 2 before 32 weeks. When checked, B-cell counts were low in 39% of newborns and normalized within 6 months. Case series: we identified 11 pregnancies (1 ongoing) in 10 women (7 MS and 3 NMOSD) treated with rituximab within 6 months of conception. All completed pregnancies resulted in term live births of healthy newborns (1 lost to follow-up at term). No maternal relapses occurred before/during pregnancy; 1 occurred postpartum (NMOSD).ConclusionNo major safety signal was observed with rituximab use within 6 months of conception. Beyond the need for monitoring neonatal B cells, these observations support prospectively monitoring a larger patient cohort to determine whether rituximab may safely protect women with MS and NMOSD who are planning a pregnancy against relapses.

The Cellular Transcriptome in the Maternal Circulation During Normal Pregnancy: A Longitudinal Study

“…Trophoblast cells facilitated the conversion of IL10-deficient B cells into IL10-expressing B cells (114), which is in line with a previous report showing that the adoptive transfer of Bregs restored maternal-fetal tolerance (112). Indeed, pregnant women treated with the B-cell-depleting treatment rituximab had a higher occurrence of pregnancy loss (115), although further investigation of this phenomenon is warranted (116).…”

Pregnancy outcomes in anti-NMDA receptor encephalitis

“…Considering our findings and those of larger series of patients with other CNS autoimmune disorders, rituximab is a potential treatment option in severely ill pregnant who fail first-line therapies. 35 Our results suggest that pregnancy is not contraindicated in women with a history of anti-NMDAR encephalitis. An important question to clarify is whether serum antibody titers in the mother and newborn correlate with the likelihood of neurologic deficits and developmental abnormalities.…”

“…Previous retrospective studies and literature reviews on pregnant patients with autoimmune demyelinating diseases treated with rituximab did not show adverse effects on patients or newborns. 35,36 Low B-cell counts may be observed in the infants, but they usually normalize spontaneously in the first 6 months without increased infection rates.…”

Peripartum hyperhemolysis prophylaxis and management in sickle cell disease: A case report and narrative review

“…[37][38][39] There are reports of B-cell depletion in the newborn when rituximab was administered in the second or third trimester of pregnancy. [40][41][42][43][44] Activation of the complement pathway has also been implicated in the pathophysiology of HS. 1,45 Eculizumab prevents the cleavage of C5 and the formation of the membrane attack complex, inhibiting complementmediated hemolysis.…”