Pre-conceptional exposure to rituximab: comment on the article by Ojeda-Uribe et al.
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LETTER TO EDITOR
Pre-conceptional exposure to rituximab: comment on the article by Ojeda-Uribe et al. Roberta Gualtierotti & Francesca Ingegnoli & Pier Luigi Meroni
Received: 30 January 2013 / Revised: 17 March 2013 / Accepted: 20 March 2013 / Published online: 2 May 2013 # Clinical Rheumatology 2013
Dear Editor, We read with great interest the article published in a recent issue of Clinical Rheumatology by Ojeda-Uribe et al. [1] on the exposure to abatacept or rituximab (RTX) in the first trimester of pregnancy in three women with autoimmune diseases. We recently observed two consecutive pregnancies after RTX exposure during the pre-conceptional period. Our patient is an Asian 33-year-old female with severe seropositive rheumatoid arthritis (RA) since 1999 and positivity for antiSSA/Ro antibody test. When she decided to have her first pregnancy she was advised to undergo fetal heart rate monitoring, due to antiRo positivity. Her first pregnancy resulted in a full-term healthy baby with normal weight. During the pregnancy, the patient was treated only with hydroxychloroquine. During the puerperium, the patient presented a polyarticular flare-up of the disease (DAS-28, 5.68). As the patient was not eligible for anti-TNF-α therapy, she was proposed and underwent RTX therapy (two 1,000 mg infusions at days 1 and 15), with good control of the disease (DAS-28, 2.8). Her second pregnancy started 12 months after the last infusion, following the current guidelines regarding pregnancy management during RTX administration. After 36 weeks, she R. Gualtierotti : F. Ingegnoli : P. L. Meroni Department of Clinical and Community Sciences, University of Milan, Milan, Italy R. Gualtierotti : F. Ingegnoli : P. L. Meroni Division of Rheumatology, Istituto Gaetano Pini, Milan, Italy R. Gualtierotti (*) G. Pini Orthopedic Institute, Milan, P.za Cardinal Ferrari 1, Milan, Italy e-mail: [email protected]
delivered an otherwise healthy baby, apart from a low birth weight (LBW) of 2,350 g. The patient received a second cycle of RTX therapy shortly after the delivery of the baby because of a very severe flare-up of the disease (DAS-28, 6.83). Although she was strongly advised to take contraceptive measures, she became pregnant of her third child after 3 months from the last infusion and was not available for follow-up visits because of her return to Pakistan. A healthy baby with LBW (2,425 g) was born at the 37th week of gestation because of premature rupture of membranes (PROM). Because of a QT prolongation, the baby underwent follow-up with cardiologic evaluation and spontaneous resolution occurred after 72 h. In agreement with previous reports, the two babies had no malformations and no perinatal infections were reported during a follow-up of 24 months and 11 months, respectively [1–4]. The babies are now in good health. Differently from Ojeda-Uribe et al., we used a full-dose cycle of 1,000 mg per infusion on days 1 and 15 of RTX, which is the currently approved scheme in RA patients in our country [www.agenziafarmaco.gov.
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