Rituximab combined with chemotherapy for lymphoma during pregnancy

Rey, Jérôme; Coso, Diane; Roger, Vianney; Bouayed, Nouha; Belmecheri, Nawel; Иванов, В. В.; Gastaut, Jean‐Albert; Bouabdallah, Réda

doi:10.1016/j.leukres.2008.04.004

Cited by 30 publications

(12 citation statements)

References 6 publications

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“…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.…”

Section: Anti-tnfαmentioning

confidence: 99%

Are biological drugs safe in pregnancy?

et al. 2015

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The introduction of biological therapies has significantly improved the outcome of inflammatory rheumatic diseases. As most of these diseases affect women and men in childbearing age, some concerns have been voiced as to the safety of these drugs in relation to reproduction and pregnancy. Data from many hundreds of pregnancies in patients affected by inflammatory bowel disease and inflammatory arthritis have suggested that exposure to anti-TNF therapies at conception and/or during pregnancy is not associated with adverse pregnancy outcomes or any increase in congenital abnormalities. However, the exposure to anti-TNFα agents, particularly to monoclonal antibodies, in late pregnancy is associated with high drug levels in the newborn and their long-term effects on children remain unknown. Therefore, limiting the use of anti-TNFα to the first 30 weeks of pregnancy is recommended to reduce fetal exposure. Live-virus vaccines should be given only when levels of anti-TNFα drugs are undetectable in the serum of infants. Studies suggest that many of these drugs do enter breast milk in small amounts, but the extent to which the infant absorbs them is less clear. Limited reports have not suggested adverse pregnancy outcomes in women whose partners were exposed to anti-TNF therapies at the time of conception. Pregnancy data for rituximab, abatacept, anakinra, tocilizumab and belimumab are limited and their use in pregnancy cannot currently be recommended.

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Section: Anti-tnfαmentioning

confidence: 99%

Are biological drugs safe in pregnancy?

et al. 2015

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“…These reports have generally found reassuring neonatal outcomes. [4][5][6][7][8][9][10][11][12] In these situations, risks of undertreating life-threatening maternal disease outweighed potential risks of antenatal exposure.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes after maternal exposure to rituximab

Chakravarty

Murray²,

Kelman³

et al. 2011

Blood

492

321

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Rituximab is a chimeric anti-CD20 monoclonal B cell-depleting antibody indicated for certain hematologic malignancies and active rheumatoid arthritis with inadequate response to tumor necrosis factor antagonists. Despite counseling to avoid pregnancy, women may inadvertently become pregnant during or after rituximab treatment. Using the rituximab global drug safety database, we identified 231 pregnancies associated with maternal rituximab exposure. Maternal indications included lymphoma, autoimmune cytopenias, and other autoimmune diseases. Most cases were confounded by concomitant use of potentially teratogenic medications and severe underlying disease. Of 153 pregnancies with known outcomes, 90 resulted in live births. Twenty-two infants were born prematurely; with one neonatal death at 6 weeks. Eleven neonates had hematologic abnormalities; none had corresponding infections. Four neonatal infections were reported (fever, bronchiolitis, cytomegalovirus hepatitis, and chorioamnionitis). Two congenital malformations were identified: clubfoot in one twin, and cardiac malformation in a singleton birth. One maternal death from pre-existing autoimmune thrombocytopenia occurred. Although few congenital malformations or neonatal infections were seen among exposed neonates, women should continue to be counseled to avoid pregnancy for < 12 months after rituximab exposure; however, inadvertent pregnancy does occasionally occur. Practitioners are encouraged to report complete information to regulatory authorities for all pregnancies with suspected or known exposure to rituximab. (Blood. 2011;117(5):1499-1506)

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“…When given during the second and third trimester it achieves fetal serum levels similar to or exceeding maternal levels at term [30][31][32]. Five new case reports have been published (Table 2) [33][34][35][36][37] and the analysis of all reports of pregnancies in the rituximab global drug safety database [38 ]. Of 153 pregnancies exposed to rituximab with known outcomes, 90 (59%) resulted in live births, 33 (22%) in spontaneous abortion, and 28 (18%) pregnancies were terminated.…”

Section: Rituximabmentioning

confidence: 99%