Rituximab
Quick read
Rituximab can be used in pregnancy to treat inflammatory illnesses. Babies who were exposed in later pregnancy might be offered some of their vaccinations at a later time than usual.
What is it?
Rituximab (Humira®) is an antibody therapy for some inflammatory illnesses, including rheumatoid arthritis, granulomatosis with polyangiitis, and microscopic polyangiitis. It is also used to treat certain types of lymphoma and leukaemia.
Benefits
What are the benefits of using rituximab in pregnancy?
Because rituximab reduces a type of white blood cell in the immune system, it is an effective treatment for some blood cancers.
Through this effect on white blood cells, rituximab can also stop the immune system from attacking the body’s tissues in some inflammatory illnesses. This is important to reduce unpleasant symptoms and prevent long-term damage. It may also lower the chance of some pregnancy problems linked to uncontrolled inflammation, including miscarriage and lower infant birth weight.
Risks
What are the risks of using rituximab in pregnancy?
Use of rituximab in pregnancy has been studied in only a small number of women. There is no suggestion that rituximab affects the baby’s development but ongoing data collection is ideally required to confirm this.
Rituximab used in later pregnancy might affect the baby’s immune system for several months after birth. Live vaccines should be avoided during this time. This means that the baby cannot be vaccinated against rotavirus (as this needs to be completed by four months) and is unlikely to be offered the BCG vaccine (if required) until they are at least six months old. A doctor will be able to advise about the best time for the baby to be given any live vaccinations.
Alternatives
Are there any alternatives to using rituximab in pregnancy?
Possibly, depending on the severity of the illness it is being used for.
Women receiving rituximab as part of cancer chemotherapy should be reviewed by their oncologist. In some cases it may be safe to stop treatment for a while. Other women may be advised to continue on the drug to ensure their condition remains well-controlled and to prevent pregnancy complications linked to the underlying illness.
Women using rituximab to treat an inflammatory condition might be advised to continue or may be switched to another medicine. Some women may find that their symptoms improve during pregnancy; if so, their specialist may advise that their medicine(s) can be altered or stopped. However, women should not change or stop their medication without speaking to their doctor.
Women using rituximab who are planning a pregnancy should speak to their GP or specialist to determine which medicine is best.
If a woman has an unplanned pregnancy while taking rituximab she should be reviewed by her doctor as soon as possible.
No treatment
What if I prefer not to take medicines during pregnancy?
It is important that blood cancers and inflammatory conditions are well-treated during pregnancy, in order to avoid a flare-up of symptoms and to reduce the chance of certain pregnancy complications. A doctor will be happy to discuss any concerns.
Will I or my baby need extra monitoring?
As part of routine antenatal care in the UK, women are invited for a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. No further scans to check for birth defects will be required, although extra growth scans may be offered. Women with the conditions that rituximab is used to treat will usually be offered closer monitoring during pregnancy.
Are there any risks to my baby if the father has used rituximab?
There is currently no evidence that rituximab used by the father can harm the baby through effects on the sperm.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.