Rituximab
More commonly used for the treatment of non-Hodgkin's lymphoma, rituximab is also used for patients with refractory RA. Although as of yet there are no reports of congenital anomalies associated with this anti-CD20 monoclonal antibody, “there are insufficient data regarding the safety of the drug in animal or human pregnancy,” said Dr. Bermas. Two case reports of successful outcomes in women treated with rituximab for non-Hodgkin's lymphoma during pregnancy are promising, but not yet representative, she said. In fact, given the availability of safer alternative medications for pregnant RA patients, along with the possibility of remission during pregnancy, rituximab should probably be avoided unless there's a compelling reason to use it, she said.
Drug Treatment Considerations
The treatment of rheumatic diseases in pregnant women should be based on disease severity and drug safety, according to Dr. Bermas, who suggested the following general guide to treatment options:
Mild Disease
▸ For inflammatory arthritis, Dr. Bermas recommends stopping drug therapy before pregnancy or when pregnancy is discovered.
▸ For SLE, maintain these patients on hydroxychloroquine.
▸ NSAIDS are acceptable up to week 24.
Moderate Disease
▸ Steroids should be used at the lowest possible dose.
▸ Azathioprine should be used with caution.
▸ Cyclosporin A should be used with caution.
▸ Sulfasalazine should be used with caution.
Severe Disease
▸ High-dose steroids should be used with caution.
▸ Azathioprine should be used with caution.
▸ Cyclosporin A should be used with caution.
▸ Cyclophosphamide should be used only in life-or-death situations.