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Rituximab, MS, and pregnancy.

Jessica B Smith1, Kerstin Hellwig1, Katharina Fink1

  • 1From the Department of Research & Evaluation (J.B.S.), Kaiser Permanente Southern California; Department of Neurology (K.H.), St. Josef Hospital, Bochum, Germany; Department of Clinical Neuroscience (K.F., F.P.), Karolinska Institute; Center for Neurology (K.F.), Academic Specialist Center, Stockholm, Sweden; Department of Obstetrics & Gynecology - Maternal Fetal Medicine (D.J.L.), Stanford University School of Medicine, Stanford, CA; Department of Neurology (F.P.), Karolinska University Hospital, Stockholm, Sweden; and Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA.

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Rituximab (RTX) treatment for multiple sclerosis (MS) during pregnancy showed no increased adverse outcomes. RTX effectively controlled MS disease activity with minimal relapses observed in treated women.

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Area of Science:

  • Neurology
  • Immunology
  • Reproductive Medicine

Background:

  • Multiple sclerosis (MS) management during pregnancy presents challenges regarding treatment safety and efficacy.
  • Rituximab (RTX), a B-cell depleting therapy, is increasingly used for MS, necessitating an understanding of its impact on pregnancy.

Purpose of the Study:

  • To evaluate the safety and efficacy of rituximab (RTX) in women with multiple sclerosis (MS) undergoing pregnancy.
  • To assess pregnancy outcomes and infant safety following maternal RTX exposure for MS.

Main Methods:

  • Retrospective cohort study of 74 pregnancies in 55 women treated with RTX for MS.
  • Data collected from electronic health records (2012-2019) including treatment history, pregnancy outcomes, and MS relapses.

Main Results:

  • No significant increase in adverse pregnancy outcomes compared to national rates.
  • Low disease activity observed, with only 2.7% of women experiencing relapses.
  • Adverse outcomes included 3 preterm deliveries, 1 neonatal death, and 1 perinatal stroke among 38 live births.

Conclusions:

  • Rituximab (RTX) appears safe and effective for managing MS during pregnancy, with outcomes comparable to general population rates.
  • Further research is needed to fully understand risks associated with prolonged B-cell depletion.
  • Current recommendations suggest restricting RTX use before pregnancy to women needing highly effective MS treatment.