title: Neuromyelitis optica and pregnancy during therapeutic B cell depletion: infant exposure to anti-AQP4 antibody and prevention of rebound relapses with low-dose rituximab postpartum.
abstract: Neuromyelitis optica (NMO) predominantly affects women, some in childbearing age, and requires early therapeutic intervention to prevent disabling relapses. We report an anti-AQP4 antibody-seropositive patient who became pregnant seven months after low-dose (100 mg) rituximab application. Pregnancy showed no complications, and low-dose rituximab restarted two days after delivery resulted in neurological stability for 24 months. Remarkably, her otherwise healthy newborn presented with anti-AQP4 antibody and reduced B lymphocyte counts in umbilical cord blood, which normalized three months later. Confirming and extending previous reports, our case suggests that low-dose rituximab might be compatible with pregnancy and prevent rebound NMO disease activity postpartum.
authors.affiliation: Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ringelstein
authors.forename: J
authors.initials: J
authors.lastname: Harmel
authors.forename: F
authors.initials: F
authors.lastname: Distelmaier
authors.forename: J
authors.initials: J
authors.lastname: Ingwersen
authors.forename: T
authors.initials: T
authors.lastname: Menge
authors.forename: K
authors.initials: K
authors.lastname: Hellwig
authors.forename: B
authors.initials: B
authors.lastname: Kieseier
authors.forename: E
authors.initials: E
authors.lastname: Mayatepek
authors.forename: H-P
authors.initials: HP
authors.lastname: Hartung
authors.forename: T
authors.initials: T
authors.lastname: Kuempfel
authors.forename: O
authors.initials: O
authors.lastname: Aktas
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000627:therapeutic use*; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D001324:Autoantigens / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology*; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D007231:Infant, Newborn / Q000097:blood* / Q000276:immunology; D008212:Lymphocyte Depletion; D009471:Neuromyelitis Optica / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D000069283:Rituximab; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: C496030:AQP4 protein, human; D058846:Antibodies, Monoclonal, Murine-Derived; D051401:Aquaporin 4; D001323:Autoantibodies; D001324:Autoantigens; D007155:Immunologic Factors; D000069283:Rituximab
keywords: Neuromyelitis optica; antibody transfer; pregnancy; relapse prevention; rituximab