SAFETY AND EFFICACY OF RITUXIMAB IN NEUROMYELITIS OPTICA SPECTRUM DISORDER (NMOSD) DURING PREGNANCY: A SYSTEMATIC REVIEW

Abstract

Background: Neuromyelitis Optica Spectrum Disorder (NMOSD) is known to present an elevated risk of disease recurrence during pregnancy and in the postnatal phase. Rituximab, an anti-CD20 monoclonal antibody, is frequently employed to mitigate relapse risk, yet its safety profile during gestation is not well established. Methods: We conducted a systematic literature search in PubMed using the terms "Rituximab," "Neuromyelitis Optica," and "Pregnancy." Of 16 records identified, seven studies—including one systematic review, one cohort analysis, two case series, and three individual case reports—met inclusion criteria. Data on rituximab exposure timing, disease stability, and maternal and fetal outcomes were extracted and evaluated. Results: Most reports indicated a reduction in disease relapse during pregnancy with rituximab use. The majority did not demonstrate increased risk of miscarriage or preterm labor compared to general population rates, though one series noted more adverse fetal events. Limitations included small sample sizes and retrospective design with potential confounding factors. Conclusions: Rituximab administered prior to conception may provide a favorable balance of benefits and risks in NMOSD management during pregnancy. Further research—especially prospective trials —is necessary to validate its safety profile.