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Fetal outcomes after rituximab exposure in women with autoimmune vasculitis
  1. William F Pendergraft III1,2,3,
  2. Martina M McGrath3,4,
  3. Andrew P Murphy2,3,
  4. Patrick Murphy3,
  5. Karen A Laliberte2,3,
  6. Michael F Greene5,
  7. John L Niles2,3
  1. 1 Joint Nephrology Fellowship Program, Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH), Boston, Massachusetts, USA
  2. 2 Division of Nephrology, Department of Medicine, MGH, Boston, Massachusetts, USA
  3. 3 Vasculitis and Glomerulonephritis Clinic, MGH, Boston, Massachusetts, USA
  4. 4 Renal Division, Department of Medicine, BWH, Boston, Massachusetts, USA
  5. 5 Department of Obstetrics and Gynecology, MGH, Boston, Massachusetts, USA
  1. Correspondence to Dr John L. Niles, Division of Nephrology, Department of Medicine, Massachusetts General Hospital (MGH), 151 Merrimac Street, Boston, MA 02114-4719, USA; jlniles{at}partners.org

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Rituximab is an approved B-lymphocyte depleting agent for induction of remission in patients with granulomatosis with polyangiitis and microscopic polyangiitis.1 ,2 Unlike cyclophosphamide, rituximab is not known to interfere with fertility and appears to be a safe and effective alternative. Pregnancy outcomes after maternal exposure to rituximab have been described,3 primarily in women with lymphoma, rheumatoid arthritis and lupus, but little is known about the impact of rituximab exposure on fetal outcomes, and more specifically, fetal B-lymphocyte populations among women with vasculitis. We performed a retrospective analysis of women with vasculitis who received rituximab in our centre and who achieved pregnancy, and their resultant offspring.

While receiving rituximab, women were counselled extensively to avoid pregnancy. Urine levels of human chorionic gonadotropin were measured and negative before each dose. …

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Footnotes

  • Contributors WFP, MMM, MFG and JLN provided the clinical care and data interpretation for the patients described herein. APM and PM assisted with data collection and interpretation. KAL serves as manager of the MGH Vasculitis and Glomerulonephritis Clinic, obtained institutional review board approval for this study and provided invaluable insight and recommendations regarding this work as well as interpretation of the data. WFP wrote and prepared the manuscript. All authors participated in reviewing the revised version of the manuscript and approved the final revised version.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Partners Healthcare System Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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