Rituximab administration during the second trimester of pregnancy for systemic lupus erythematosus: Case report and review of the literature on rheumatic disease

Rituximab (RTX) is an anti-CD20 monoclonal antibody that is used in the treatment of many rheumatic diseases, for both licensed and unlicensed indications. Due to concerns regarding foetal B cell depletion and possible infection, there is conflicting advice about whether the drug should be administered during pregnancy, with some organisations advising administration if the potential benefit to the mother outweighs the risk to the foetus and some advising stopping RTX 6 months prior to conception. Caution in particular is advised about administering RTX in later trimesters when maternal immunoglobulin G (IgG) is transported across the placenta. There have been few literatures thus far examining the safety of administering RTX from the second trimester onwards in rheumatic diseases. We present a case where RTX was used during the second trimester for the treatment of refractory systemic lupus erythematosus, without adverse effect on the neonate.