Rituximab for autoimmune blistering diseases in pregnancy and children: a clinical review

To critically review the current literature on the safety, efficacy, and clinical considerations of rituximab use in pediatric and pregnant patients with autoimmune blistering diseases (AIBD).

A comprehensive literature search was conducted using PubMed and Embase to identify relevant articles, including case reports, case series, observational studies, and systematic reviews.

Studies were selected based on relevance to rituximab use in pediatric and antenatal AIBD, with particular focus on treatment efficacy, adverse outcomes, and long-term immunologic effects.

Rituximab demonstrates promising efficacy in pediatric AIBD, though concerns remain regarding persistent hypogammaglobulinemia and delayed immune reconstitution. In regards to pregnant patients, current data do not suggest a consistent association between rituximab exposure and congenital anomalies or serious neonatal complications, particularly when used preconception or early in gestation. Reported neonatal B-cell depletion has been transient. Multidisciplinary oversight is critical given the clinical complexity of these populations.

Rituximab may be a viable corticosteroid-sparing option for severe or refractory AIBD in children and pregnant women. Its use should be individualized and carefully monitored by experienced multidisciplinary teams. Larger prospective studies are needed to inform evidence-based guidelines.