Rituximab

• Severe/refractory RA, SLE, or vasculitis when other agents have failed — specialist-led

Binds CD20 on B-lymphocytes → antibody-dependent B-cell depletion.

• IgG placental transfer is minimal before ~20 weeks — 1st-trimester exposure lowest risk
• Transfer rises sharply from ~22–26 weeks → neonatal B-cell depletion likely if given 2nd/3rd trimester
• B-cell counts normalise in the infant by ~6 months — no consistent infection excess reported

Typical regimen

1g IV × 2 doses, 2 weeks apart (rheum indications) — specialist protocol

• CautionActive severe infection

• Infusion reactions
• ↑ infection risk
• Neonatal B-cell depletion / cytopenias if given in pregnancy

• • EULAR supports use when necessary for maternal disease control; BSR is more cautious, advising avoidance at conception with individualised use in severe disease.
• • If given in pregnancy, expect transient infant B-cell depletion — defer live vaccines and monitor infant immune status.
• • Conception ~3.5 months (≈5 half-lives) after last infusion minimises fetal exposure risk if planning pregnancy.

• Live vaccines

  Avoid

  Avoid in mother during treatment; defer in exposed infant

• 💡 Reserve for genuinely severe/refractory disease — this is a specialist rheumatology decision, not a routine pregnancy-safe substitute for other DMARDs.