Rituximab
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Rituximab can be used in pregnancy if recommended by a specialist. Babies exposed in the womb after the first trimester might be offered some of their vaccinations later than usual.
What is it?
Rituximab (MabThera®; Ituxredi®; Rixathon®; Ruxience®; Truxima®) is an antibody therapy used to treat certain types of lymphoma and leukaemia. It is also used for some inflammatory illnesses, including rheumatoid arthritis, granulomatosis with polyangiitis, and microscopic polyangiitis.
Benefits
What are the benefits of using rituximab in pregnancy?
Rituximab it is an effective treatment for some blood cancers.
Rituximab also treats inflammatory illnesses by stopping your immune system from attacking your body. 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 your baby having a low birth weight.
Risks
What are the risks of using rituximab in pregnancy?
The available information does not suggest that rituximab use in pregnancy harms your baby, but more data collection is needed to confirm that rituximab is safe.
If you use rituximab in later pregnancy, it can potentially affect your baby’s immune system for up to six months after birth. Live vaccines should be avoided during this time. This means that your baby cannot be vaccinated against rotavirus (as this needs to be completed by four months). If your baby needs the live BCG vaccine (to protect against TB infection), your doctor will help you weigh up the benefits and possible risks to your baby.
Alternatives
Are there any alternatives to using rituximab in pregnancy?
Possibly, depending on your illness.
If you are receiving rituximab for cancer, your treatment should be reviewed by your oncologist. Sometimes it is possible to pause treatment for a while, or you may be advised to continue rituximab to ensure your condition remains well-controlled and to prevent pregnancy complications.
If you are using rituximab to treat an inflammatory condition, you might be advised to continue it or to switch to a different medicine. Please do not stop your medication without speaking to your doctor.
If you are planning a pregnancy, you should speak to your specialist to determine which medicine is best. This can be arranged through your GP or specialist clinic.
If you become pregnant while taking rituximab, you should be reviewed by your doctor as soon as possible.
No treatment
What if I prefer not to take rituximab during pregnancy?
Your doctor will be happy to discuss any of your concerns. It is important that your illness is well-treated during pregnancy in order to avoid a flare-up of symptoms and to keep you healthy, as well as to reduce the chance of pregnancy complications.
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 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.