Extract

Sir, RA affects women more than men and often during childbearing years. Treatment during pregnancy is necessary to control maternal disease in favour of successful pregnancy outcome [1]. Rituximab, a chimeric immunoglobulin G1 (IgG1) monoclonal anti-CD20 antibody depletes circulating B cells and decreases RA activity [2].

Few data have been published concerning safety of rituximab during pregnancy. Placental passage of rituximab during the first trimester is minimal, significant during the second trimester and extensive in the third [3, 4], and may affect fetal and neonatal B-cell development, potentially leading to increased susceptibility to infections. Studies in cynomolgus monkeys exposed during pregnancy to therapeutic doses of rituximab showed no evidence of teratogenic effects. However, B cells were reduced in the offspring and returned to normal within 6 months after birth [5]. Since human studies are lacking, data from animal studies are insufficient, and rituximab is detectable in serum for up to 6 months, women of childbearing age are advised to use contraception during treatment and 12 months thereafter [6].

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