Is rituximab (Rituxan) safe for pregnant women with rheumatoid arthritis (RA)?

Updated: May 11, 2018
  • Author: Katherine K Temprano, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Rituximab (Rituxan), a monoclonal antibody that inhibits CD20 antigen on B lymphocytes, is indicated for the treatment for moderate to severe RA. It is a pregnancy category C medication and should be stopped 12 months prior to attempting conception. 

Case reports have also shown that rituximab therapy results in detectable levels of the drug in cord blood and results in B-cell depletion in the mother and the neonate. [44, 45, 46, 47, 48, 49]

Recovery of B-cell levels in the neonate has been reported to occur at age 3-4 months and does not appear to impair antibody formation in response to immunizations. The dosing of rituximab in case reports was 375 mg/m2 for 1-6 cycles. Mothers and newborns exposed to rituximab during second and third trimester should be monitored for the risk of infections, since neutropenia and B-cell depletion have been described in newborns. [44, 48, 49]


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