Rituxan is not completely safe during pregnancy
Rituxan is not completely safe during pregnancy

Rituxan (Rituximab) may not be completely safe during pregnancy and should be stopped at least 12 months before attempting to conceive. Rituximab may be used in early pregnancy for exceptional cases, but it should be avoided in the last trimester. Rituximab is prescribed for the treatment of moderate to severe rheumatoid arthritis and works by inhibiting specific protein on lymphocytes (a type of white blood cell).

Mothers and infants exposed to rituximab in the second and third trimester should be monitored for the risk of infections and low white blood cell count, especially the cells called lymphocytes. 

Which other rheumatoid arthritis drugs are safe in pregnancy?

Antirheumatoid drugs that are safe to use during pregnancy are as follows:

  • Plaquenil (hydroxychloroquine): It is completely safe to take throughout pregnancy.
  • Infliximab/adalimumab: It is safe to use up to 20 weeks of pregnancy period. In exceptional cases, it can be used throughout pregnancy.
  • Enbrel (Etanercept): It can be continued up to 30 to 32 weeks of pregnancy. In extreme cases, it may be used throughout pregnancy.
  • Certolizumab: It is safe to use in all nine months of the pregnancy.
  • Golimumab: It is advised to take this medicine only in the first three months of pregnancy.
  • Kineret (Anakinra): This drug is used to treat severe rheumatoid arthritis and prescribed when most of the options fail during pregnancy. In the first three months, this is relatively safe, but in the following months, the drug may cause ill effects in the unborn baby.
  • Orencia (abatacept): It is not safe in pregnancy and may cause side effects like cleft palate, facial abnormalities, and brain developmental abnormalities in the unborn baby. It is to be used only if no other options are available.

Does rituximab cross the placenta?

Rituximab may cross the placenta in the later stages of pregnancy. However, there are no studies to prove whether rituximab causes birth defects in the newborns. Mothers and infants exposed to rituximab in the second and third trimester should be monitored for the risk of infections and abnormally low white blood cell counts. Low counts of specific white blood cells may make the newborn prone to infections.

Can rituximab cause miscarriage or stillbirth?

No study has linked rituximab to miscarriage or stillbirth; therefore, more research into this subject is essential.

Can rituximab cause infertility?

Rituximab has not known to cause infertility and appears to be a safe and effective alternative. The use of rituximab before pregnancy is well tolerated. It is advised to stop the drug 12 months before attempting to conceive.

Can rituximab cause preterm birth?

Rituximab may not cause preterm birth or low birth weight babies, but rheumatoid arthritis has shown to increase the risk of preterm birth. More research is required to conclude about rituximab and its association with the preterm birth if any.

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

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Medically Reviewed on 8/17/2020
References
https://emedicine.medscape.com/article/335186-overview#a4

https://www.medicinesinpregnancy.org/Medicine--pregnancy/Rituximab/