How do you approach the timing of Rituximab during pregnancy in a patient with life or organ threatening autoimmune disease?

The short answer is that I give it whenever it is needed for organ or life-threatening disease. Giving it earlier in pregnancy may have less impact on the fetus/neonate. In general, we all try to avoid routine treatment with rituximab during pregnancy due to the expected placental transfer after the first trimester, and if a patient is stable on this regimen, I would ideally administer a dose just before conception (as far as that can be timed). While the immunologic effect of
rituximab lasts six...

The ACR guidelines conditionally recommend continuing Rituximab in life and/or organ threatening disease during pregnancy. If possible, I try to dose Rituximab as early into the pregnancy as possible. I typically use the dosing regimen 1g every 6 months. If you have a patient where you are discussing preconception counseling and planning for a pregnancy within the next year, I typically recommend the patient attempt to conceive as close to their Rituximab infusion date as possible so that it can...

I frequently administer Rituximab to pregnant patients with SLE, Sjogrens, Myositis, RA, and AAV in the first trimester. The passage of large monoclonal antibodies is very low at this point in pregnancy. Studies in rheumatology, oncology, and neurology patients have not shown substantial risks for miscarriage or congenital malformations. Babies born to mothers who had received rituximab or other B cell targeted therapies have not demonstrated an increased risk of infection or lack of vaccine eff...