Effect of Rituximab on pregnancy outcome in women with Rheumatoid Arthritis

What is it about?

Rituximab is a type of drug called a biological therapy used for treating individuals with Rheumatoid Arthritis (RA). Rituximab works by depleting the B‐cells to reduce inflammation and improve symptoms. It can cross the placenta from the beginning of the second trimester and therefore could have effects on the foetus. Current guidelines advise that you take care to avoid becoming pregnant for at least six months after treatment. In general, we know little how rituximab might affect pregnancy. Mostly single cases of rituximab use before or during pregnancy are reported, with a majority of cases in patients with other diseases than RA. This report summarises 32 cases of women with RA who received rituximab in any period before conception in the British Society for Rheumatology Biologics Register for RA (BSRBR-RA). No women received rituximab during pregnancy. Rituximab was received in 10 cases within 6 months of conception, 8 women received rituximab between 6 and 12 months before conception and 14 women received rituximab at 12 months or longer before conception. Overall, the majority of women had live births (66%) and could restart rituximab after delivery. No major foetal or maternal harm was detected in any case. Moreover, no notable differences were observed between the groups of women having different time windows between rituximab exposure and conception.

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Why is it important?

The results of this study are reassuring for the use of rituximab before conception. However, this study reports on a small number of women and more evidence is needed.

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