Rituximab

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Article initiated by:
Evan Wotipka, MD
All contributors:
Iya Abdulkarim, BA, MA, Karen Armbrust MD PhD, Evan Wotipka, MD
Assigned editor:
Review:
Assigned status Update Pending
.


Medical Therapy

Description

Rituximab is a chimeric anti-CD20 monoclonal antibody with murine-antigen binding regions fused to human IgG1 constant domains. This biologic agent depletes B lymphocytes.

Rituximab was first approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of lymphoma. Although originally developed for the treatment of B-cell lymphomas, rituximab’s use has expanded to include a range of autoimmune and inflammatory diseases including rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), and pemphigus vulgaris (PV).[1]

Among pediatric populations, rituximab is indicated for the treatment of GPA and MPA in combination with glucocorticoids in pediatric patients 2 years of age and older. Additionally, it is approved as an adjuvant to chemotherapy for patients between 6 months and 18 years of age with previously untreated, advanced stage, CD20-positive diffuse large B-cell lymphoma, Burkitt-like lymphoma, or mature B-Cell acute leukemia.[2][3]

Growing evidence supports the use of rituximab to treat specific ocular conditions and autoimmune diseases with ocular involvement.[4][5] Rituximab is effective and well-tolerated as second- or third-line therapy for patients with refractory scleritis and noninfectious uveitis (NIU) and may allow for inflammatory disease control while reducing reliance on concomitant corticosteroids.[6][7]

Other roles in ocular inflammatory disease include peripheral ulcerative keratitis (PUK) and associated scleritis, ocular cicatricial pemphigoid, orbital inflammatory disease, and autoimmune retinopathy. Additionally, rituximab plays a role in ocular disease as a treatment for vitreoretinal lymphoma.

Clinical Pharmacology

Rituximab is a chimeric (murine and human) monoclonal antibody that targets CD20. CD20 is an antigen expressed on the surface of pre-B and mature B-lymphocytes, and is found on both normal and malignant B-cells. However, CD20 is not found on normal plasma cells, hematopoietic stem cells, or pro-B-cells. B-cell lysis is mediated by the binding of rituximab to the transmembrane antigen CD20. Proposed mechanisms of cell lysis include the combined effects of antibody-dependent cell-mediated cytotoxicity and phagocytosis, complement-mediated cell lysis, growth arrest, and B-cell apoptosis.[1][4]

Patient Selection

Indications

Growing evidence supports the use of rituximab for the treatment of noninfectious ocular inflammatory disease refractory to corticosteroid therapy and disease-modifying antirheumatic drugs. Rituximab also may be beneficial in a corticosteroid-sparing strategy. Although rituximab use for noninfectious ocular inflammatory disease is presently off-label unless the patient has an approved systemic disease indication, it has been extensively used for this indication with documented efficacy in multiple studies.[6][7][8][9]

Scleritis

Scleritis, or the inflammation of the episcleral and scleral tissues, may involve the uvea and can be vision threatening. In up to 50% of patients experiencing scleritis, it is associated with an underlying systemic disease.[10]

Rituximab is often used as a treatment for patients with scleritis associated with RA and GPA as it is an effective and FDA-approved indication for these systemic diseases. A 2014 Phase I/II clinical trial demonstrated effective treatment for 9 of 12 patients with refractory, noninfectious scleritis.[11] A second cycle of rituximab infusions was required for 7 among those 9 to maintain inflammatory control after breakthrough inflammation. Peri-infusional oral corticosteroids were successful in managing 4 cases of peri-infusional inflammatory exacerbations.

Peripheral ulcerative keratitis

Peripheral ulcerative keratitis (PUK) is a group of inflammatory diseases resulting in peripheral corneal thinning[12], and has been associated with several autoimmune disorders. Steroid-sparing agents, including rituximab, are indicated in patients with associated RA due to increased risk for vascular events.

In a multicenter study of biologic-treated patients with severe PUK refractory to conventional immunosuppressive drugs, rituximab was among several biologics identified as promising alternative regimens.[13]

Rituximab has been used in the treatment of PUK associated with both RA and GPA. Among three cases of PUK associated with RA (2 with necrotising scleritis and one with only PUK), the two patients who received rituximab stabilized from an ocular standpoint.[14] In a retrospective study of patients with GPA-associated PUK, rituximab achieved remission in all 11 patients and is favored as a first-line agent for halting progression.[15]

Orbital inflammatory syndrome recalcitrant to corticosteroids

A review of inflammatory modulators and biologic agents in the treatment of idiopathic orbital inflammation (IOI) suggests that most patients achieve adequate disease control with corticosteroids alone; however, biologic agents such as rituximab may be beneficial in select cases.[16] Proposed mechanisms suggest a role for IL-2 mediated immune activity in IOI while rituximab exerts its effect through CD20-directed B-cell depletion, contributing to disease control.[17]

Reports describe successful treatment of corticosteroid-refractory IOI with rituximab. The first reported successful use of rituximab in a patient with refractory IOI was in combination with CyberKnife radiosurgery.[18] Savino and colleagues reported successful treatment of IOI using intraorbital rituximab injections in three patients.[19]

Juvenile idiopathic arthritis associated uveitis

Rituximab therapy has also been successful in treatment of refractory juvenile idiopathic arthritis (JIA)-associated uveitis.[20][21] In a study of limited sample size, rituximab has shown efficacy in the treatment of children with juvenile idiopathic arthritis associated uveitis, with 7 of 8 patients achieving complete control of the uveitis.[21] Rituximab use allowed reduction in concomitant prednisone dosage in all 8 patients, as well as discontinuation of systemic immunosuppressants in 5 of 8 patients.[22]

Noninfectious Uveitis

Compared to other treatments of NIU, rituximab serves as a rescue therapy for refractory cases when first- and second-line treatment options (i.e. Disease-modifying antirheumatic drugs (DMARDs) and TNF-alpha inhibitors, respectively) are unsuccessful in achieving improvement or control of uveitis. In a case series of 11 patients with refractory noninfectious posterior uveitis, treatment with rituximab demonstrated control of inflammation in 81% of patients as well as improvement of visual acuity from 20/80 to 20/40.[23]

Autoimmune retinopathy

Autoimmune retinopathy (AIR) is caused by a presumed autoimmune reaction where antibodies are directed against retinal structures and is classified as a posterior uveitis. A 2017 report of five patients described stabilization of non-paraneoplastic AIR (npAIR) refractory to other immunosuppressive therapies.[24] A case series of 16 patients also published in 2017 demonstrated stabilization or improvement in a majority of patients being treated with rituximab. A subsequent Phase I/II clinical trial found rituximab to be well tolerated as an agent in npAIR therapy, however it did not demonstrate definitive clinical improvement.[25] A 2025 meta-analysis evaluating evidence of rituximab and interleukin-6 (IL-6) inhibitors highlighted the role of biologics in significantly reducing morphological and functional retinal changes in npAIR therapy.[26] Combination therapy with rituximab and bortezomib may be of higher efficacy with inner retinal involvement.[27]

Susac syndrome

Susac syndrome is a rare retinal vasculitis, and retinal vasculitis entities are often considered posterior uveitis. Rituximab is used as a second-line for refractory cases of Susac Syndrome or relapse.[28][29] It is also considered as an add-on immunosuppressive agent for severe cases.

Ocular cicatricial pemphigoid

Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune blistering disease of the conjunctiva that causes progressive conjunctival scarring. As a systemic disease, OCP requires systemic treatment options with immunomodulatory therapy being a primary consideration. Rituximab is among such primary treatment options.

A retrospective cohort study highlighted the effectiveness and safety of both rituximab monotherapy as well as combination therapy in treating severe OCP.[30] Similarly, a 2025 review of patients receiving rituximab in combination with intravenous immunoglobulin (IVIG) demonstrated effective treatment of pemphigoid in recalcitrant cicatrizing conjunctivitis.[31]

Vitreoretinal lymphoma

Rituximab is commonly employed in the management of vitreoretinal lymphoma (VRL) as part of a multimodal treatment approach to achieve local disease control. It is administered via intravitreal injection alongside or as an alternative to methotrexate, targeting CD20-positive B-cell lymphoma cells within the vitreous and retina.[32] Although the intravitreal dose of rituximab in VRL treatment is consistent at 1 mg (0.1 mL) across reports, frequency of the injections varies considerably.

Neuromyelitis optica spectrum disorder

Rituximab is one of several immunotherapies used for long-term management of neuromyelitis optica (NMO) spectrum disorders. Early cases demonstrating rituximab’s utility in preventing relapses in NMO[33] gave rise to its off-label use in additional reports and investigations. These findings informed recommendations in the early 2010s endorsing rituximab as a first-line maintenance therapy.[34] Subsequent meta-analysis of rituximab use in NMO underscores acceptable tolerance, reduction of relapse frequency, and improvement of disability.[35] Monoclonal antibody therapies that have been approved for adults with NMO spectrum disorders include eculizumab, inebilizumab, and satralizumab.[36] Obtaining insurance coverage for rituximab to treat NMO may present an obstacle because of its off-label use.

Warnings/Precautions

General

Rituximab may cause infusion reactions, tumor lysis syndrome, mucocutaneous reactions, progressive multifocal leukoencephalopathy, Hepatitis B reactivation, infections, cardiac arrhythmias, renal toxicity, and bowel obstruction and perforation.[1]

Refer to section 4 for further details regarding adverse reactions.

Drug Interactions

The FDA recognizes an interaction between rituximab and concomitant cisplatin therapy resulting in renal toxicity. Rituximab products have not undergone formal drug interaction studies.

Patients who have received prior antibody therapies may experience allergic or hypersensitivity reactions when treated with other monoclonal antibodies due to human anti-mouse antibody or anti-drug antibody titers.[37]

Carcinogenesis/Mutagenesis/Impairment of Fertility

Standard tests investigating mutagenicity have not been performed as they are not relevant for monoclonal antibodies. No long-term animal studies have been performed to establish the carcinogenic potential of rituximab nor its effects on fertility. General toxicology animal studies did not reveal deleterious effects on reproductive organs.

Pregnancy

Neonatal Fc receptor-mediated transport allows rituximab to cross the placenta, with fetal drug levels matching maternal levels by week 26.[38] While in utero exposure raises concerns for neonatal B-cell depletion, heightened infection risk, and impaired vaccine responsiveness, reported cases have largely been limited to transient B-cell lymphocytopenia and infections in exposed infants.[39] Regulatory guidance recommends delaying live vaccinations of rituximab-exposed infants until 6 months of age due to limited data. The American College of Rheumatology recommends discontinuing rituximab once pregnancy is confirmed with a conditional recommendation to continue rituximab during pregnancy in cases of life- or organ-threatening maternal disease.[40][41]

Nursing Mothers

Rituximab is the only non-TNF inhibitor biologic to have received a strong recommendation for breastfeeding from American College of Rheumatology (ACR).[39] Among mothers receiving rituximab postpartum, there was no difference in the growth nor development of infants who were breastfed as compared to those who were not.[42]

Contraindications

Patients must undergo testing for hepatitis B virus (HBV) infection prior to initiation of rituximab therapy as it may cause HBV reactivation.[4]

Relative contraindications are outlined above in sections 3.1-3.4.

Adverse Reactions

Documented adverse reactions to rituximab therapy are listed below.[1]

Infusion reactions: Severe and even fatal infusion-related reactions have been observed within 24 hours of rituximab infusion. Approximately 80% of fatal reactions occurred with first infusion. It is recommended to premedicate patients with an antihistamine and acetaminophen. Patients should be closely monitored and rituximab infusion should be discontinued if severe reactions occur.

Tumor Lysis Syndrome: Acute renal failure, hyperkalemia, hypocalcemia, hyperuricemia, or hyperphosphatemia may occur as a result of tumor lysis within 12-24 hours after first infusion.  

Severe mucocutaneous reactions: Onset of mucocutaneous reactions, some fatal, have been reported with onset ranging between 1-13 weeks after rituximab exposure.

Progressive multifocal leukoencephalopathy (PML): Cases of PML, including fatal events, have been reported in patients with hematologic malignancies or autoimmune diseases treated with rituximab. Diagnosis of PML was made within 12 months of the last rituximab infusion in most cases.

Infections: Reactivation of Hepatitis B virus (HBV) has been observed, with some cases progressing to fulminant hepatitis, hepatic failure, and death. Other viral, bacterial, and fungal infections can develop following rituximab exposure in the context of B-cell depletion.

Cardiac arrhythmias: Patients with a known history of or new development of cardiac arrhythmia should undergo cardiac monitoring during and after infusions.

Dosage and Administration

Relevant case series and clinical trials typically employed rheumatologic protocol consisting of two 1000 mg infusions administered 14 days apart, followed by maintenance dosing at 6 months.[6][7]

There are also weekly x4-5 and monthly administration regimens that are less commonly used for uveitis but may be used for ocular cicatricial pemphigoid (OCP). OCP is a chronic autoimmune blistering disease of the conjunctiva that causes progressive conjunctival scarring (see section 2.1 for additional information). Rituximab is used more commonly in OCP protocols than in uveitis.

A 2017 retrospective cohort study established rituximab as a safe and effective option for the treatment of OCP with a weekly dosing of 375 mg/m2 weekly for 8 weeks, followed by monthly treatment for ocular inflammatory disease.

A study of rituximab therapy for refractory scleritis did not demonstrate a significant difference in efficacy, toxicity, or likelihood of re-treatment between patients given 500 mg vs. 1000 mg of rituximab intravenous infusions.[11]

Rituximab may be administered as an intravenous infusion or as an intravitreal injection. In the case of the former, acetaminophen and antihistamines are given before each infusion.[11] Rituximab also may be administered as an intravitreal injection (1 mg/0.1 mL) for the treatment of vitreoretinal lymphoma.[32] A multicenter retrospective cohort study exploring the use of intravitreal rituximab for treatment of vitreoretinal lymphoma most commonly dosed at a monthly frequency.[43]

References

  1. ↑ 1.0 1.1 1.2 1.3 U.S. Food and Drug Administration. Rituxan (rituximab) Label. Accessed January 19, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/103705s5311lbl.pdf
  2. ↑ FDA approves Roche’s Rituxan (rituximab) in children with two rare blood vessel disorders. Accessed March 24, 2026. https://www.roche.com//media/releases/med-cor-2019-09-30b
  3. ↑ Research C for DE and. FDA approves rituximab plus chemotherapy for pediatric cancer indications. FDA. Published online August 9, 2024. Accessed March 24, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-rituximab-plus-chemotherapy-pediatric-cancer-indications
  4. ↑ 4.0 4.1 4.2 Thomas AS. Biologics for the treatment of noninfectious uveitis: current concepts and emerging therapeutics. Curr Opin Ophthalmol. 2019;30(3):138. doi:10.1097/ICU.0000000000000562
  5. ↑ Pelegrin L, Jakob E, Schmidt-Bacher A, et al. Experiences with Rituximab for the Treatment of Autoimmune Diseases with Ocular Involvement. J Rheumatol. 2014;41(1):84-90. doi:10.3899/jrheum.130206
  6. ↑ 6.0 6.1 6.2 Al Ghulaiga FM, Alharbi I, Albloushi AF, Dheyab AM, Abouammoh MA, Abu El-Asrar AM. Safety and efficacy of rituximab in refractory noninfectious uveitis and scleritis. J Ophthalmic Inflamm Infect. 2025;15(1):70. doi:10.1186/s12348-025-00522-5
  7. ↑ 7.0 7.1 7.2 Ng CC, Sy A, Cunningham ET. Rituximab for non-infectious Uveitis and Scleritis. J Ophthalmic Inflamm Infect. 2021;11(1):23. doi:10.1186/s12348-021-00252-4
  8. ↑ Miserocchi E, Pontikaki I, Modorati G, Bandello F, Meroni PL, Gerloni V. Rituximab for Uveitis. Ophthalmology. 2011;118(1):223-224. doi:10.1016/j.ophtha.2010.07.031
  9. ↑ Cao H, Ma X. Rituximab in the Treatment of Non-Infectious Uveitis: A Review. J Inflamm Res. 2024;17:6765-6780. doi:10.2147/JIR.S477708
  10. ↑ Okhravi N, Odufuwa B, McCluskey P, Lightman S. Scleritis. Surv Ophthalmol. 2005;50(4):351-363. doi:10.1016/j.survophthal.2005.04.001
  11. ↑ 11.0 11.1 11.2 Suhler EB, Lim LL, Beardsley RM, et al. Rituximab Therapy for Refractory Scleritis: Results of a Phase I/II Dose-Ranging, Randomized, Clinical Trial. Ophthalmology. 2014;121(10):1885-1891. doi:10.1016/j.ophtha.2014.04.044
  12. ↑ Peripheral Ulcerative Keratitis - EyeWiki. Accessed March 24, 2026. https://eyewiki.org/Peripheral_Ulcerative_Keratitis
  13. ↑ Dominguez-Casas LC, Sánchez-Bilbao L, Calvo-Río V, et al. Biologic therapy in severe and refractory peripheral ulcerative keratitis (PUK). Multicenter study of 34 patients. Semin Arthritis Rheum. 2020;50(4):608-615. doi:10.1016/j.semarthrit.2020.03.023
  14. ↑ Hardy S, Hashemi K, Catanese M, et al. Necrotising Scleritis and Peripheral Ulcerative Keratitis Associated with Rheumatoid Arthritis Treated with Rituximab. Klin Monatsbl Augenheilkd. 2017;234(4):567-570. doi:10.1055/s-0042-121315
  15. ↑ Ebrahimiadib N, Modjtahedi BS, Roohipoor R, Anesi SD, Foster CS. Successful Treatment Strategies in Granulomatosis With Polyangiitis-Associated Peripheral Ulcerative Keratitis. Cornea. 2016;35(11):1459-1465. doi:10.1097/ICO.0000000000000919
  16. ↑ Yoon MK, Lu JE. An Evidence-Based Approach to Diagnosing Patients Presenting With Orbital Inflammatory Syndromes (An American Ophthalmological Society Thesis). Am J Ophthalmol. 2024;266:156-181. doi:10.1016/j.ajo.2024.05.010
  17. ↑ Carruth BP, Wladis EJ. Inflammatory modulators and biologic agents in the treatment of idiopathic orbital inflammation. Curr Opin Ophthalmol. 2012;23(5):420. doi:10.1097/ICU.0b013e328355715e
  18. ↑ On AV, Hirschbein MJ, Williams HJ, Karesh JW. CyberKnife radiosurgery and rituximab in the successful management of sclerosing idiopathic orbital inflammatory disease. Ophthal Plast Reconstr Surg. 2006;22(5):395-397. doi:10.1097/01.iop.0000231549.24125.7a
  19. ↑ Savino G, Battendieri R, Siniscalco A, et al. Intraorbital injection of Rituximab in idiopathic orbital inflammatory syndrome: case reports. Rheumatol Int. 2015;35(1):183-188. doi:10.1007/s00296-014-3054-7
  20. ↑ Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology. 2011;50(8):1390-1394. doi:10.1093/rheumatology/ker107
  21. ↑ 21.0 21.1 Miserocchi E, Modorati G, Berchicci L, Pontikaki I, Meroni P, Gerloni V. Long-term treatment with rituximab in severe juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol. 2016;100(6):782-786. doi:10.1136/bjophthalmol-2015-306790
  22. ↑ Miserocchi E, Pontikaki I, Modorati G, Gattinara M, Meroni PL, Gerloni V. Anti-CD 20 monoclonal antibody (rituximab) treatment for inflammatory ocular diseases. Autoimmun Rev. 2011;11(1):35-39. doi:10.1016/j.autrev.2011.07.001
  23. ↑ Lasave AF, You C, Ma L, et al. LONG-TERM OUTCOMES OF RITUXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS POSTERIOR UVEITIS REFRACTORY TO CONVENTIONAL IMMUNOSUPPRESSIVE THERAPY. Retina. 2018;38(2):395-402. doi:10.1097/IAE.0000000000001563
  24. ↑ Boudreault K, Justus S, Sengillo JD, et al. Efficacy of rituximab in non-paraneoplastic autoimmune retinopathy. Orphanet J Rare Dis. 2017;12(1):129. doi:10.1186/s13023-017-0680-7
  25. ↑ Armbrust KR, Fox AR, Jeffrey BG, Sherry P, Sen HN. Rituximab for autoimmune retinopathy: Results of a Phase I/II clinical trial. Taiwan J Ophthalmol. 2021;11(1):64-70. doi:10.4103/tjo.tjo_32_20
  26. ↑ Kapoor I, Sarvepalli SM, Grewal DS, Hadziahmetovic M. Clinical Outcomes of Therapeutic Interventions for Autoimmune Retinopathy: A Meta-analysis and Systematic Review. Ophthalmol Sci. 2025;5(1):100622. doi:10.1016/j.xops.2024.100622
  27. ↑ Maleki A, Colombo A, Look-Why S, Peter Y Chang BA, Anesi SD, Anesi SD. Rituximab Monotherapy versus Rituximab and Bortezomib Combination Therapy for Treatment of Non-paraneoplastic Autoimmune Retinopathy. J Ophthalmic Vis Res. 2022;17(4):515-528. doi:10.18502/jovr.v17i4.12304
  28. ↑ Rennebohm RM, Asdaghi N, Srivastava S, Gertner E. Guidelines for treatment of Susac syndrome - An update. Int J Stroke Off J Int Stroke Soc. 2020;15(5):484-494. doi:10.1177/1747493017751737
  29. ↑ Moheb N, Tajfirouz DA, Chodnicki KD, et al. Outcomes of Maintenance Immunotherapy in a Cohort of Patients With Susac Syndrome: A 2-Center Large Case Series. Neurol Clin Pract. 2025;15(6):e200544. doi:10.1212/CPJ.0000000000200544
  30. ↑ You C, Lamba N, Lasave AF, Ma L, Diaz MH, Foster CS. Rituximab in the treatment of ocular cicatricial pemphigoid: a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. 2017;255(6):1221-1228. doi:10.1007/s00417-017-3603-3
  31. ↑ Johnny B, Thompson KN, Eziama E, Dominguez AR, Cao JH. Rituximab and intravenous immunoglobulin in the treatment of cicatrizing conjunctivitis associated with pemphigoid. AJO Int. 2025;2(1):100087. doi:10.1016/j.ajoint.2024.100087
  32. ↑ 32.0 32.1 Kvopka M, Lake SR, Smith JR. Intraocular chemotherapy for vitreoretinal lymphoma: A review. Clin Experiment Ophthalmol. 2020;48(2):240-248. doi:10.1111/ceo.13668
  33. ↑ Cree BAC, Lamb S, Morgan K, Chen A, Waubant E, Genain C. An open label study of the effects of rituximab in neuromyelitis optica. Neurology. 2005;64(7):1270-1272. doi:10.1212/01.WNL.0000159399.81861.D5
  34. ↑ Tahara M, Oeda T, Okada K, et al. Safety and efficacy of rituximab in neuromyelitis optica spectrum disorders (RIN-1 study): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2020;19(4):298-306. doi:10.1016/S1474-4422(20)30066-1
  35. ↑ Gao F, Chai B, Gu C, et al. Effectiveness of rituximab in neuromyelitis optica: a meta-analysis. BMC Neurol. 2019;19(1):36. doi:10.1186/s12883-019-1261-2
  36. ↑ Wingerchuk DM, Lucchinetti CF. Neuromyelitis Optica Spectrum Disorder. N Engl J Med. 2022;387(7):631-639. doi:10.1056/NEJMra1904655
  37. ↑ Ali SB, Yuson C, Hissaria P. Rituximab hypersensitivity reactions and tolerance of ofatumumab therapy. Clin Exp Rheumatol. 2021;39(3):648-650. doi:10.55563/clinexprheumatol/z3mbin
  38. ↑ Chakravarty EF, Murray ER, Kelman A, Farmer P. Pregnancy outcomes after maternal exposure to rituximab. Blood. 2011;117(5):1499-1506. doi:10.1182/blood-2010-07-295444
  39. ↑ 39.0 39.1 Siegel CH, Sammaritano LR. Biologic Disease-Modifying Antirheumatic Drug Use During Pregnancy and Lactation. Obstet Gynecol. Published online February 19, 2026. doi:10.1097/AOG.0000000000006193
  40. ↑ Rituximab (Rituxan & MabThera) | American College of Rheumatology. Accessed April 13, 2026. https://rheumatology.org/patients/rituximab-rituxan-and-mabthera
  41. ↑ Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020;72(4):529-556. doi:10.1002/art.41191
  42. ↑ Anderson A, Rowles W, Poole S, et al. Anti-CD20 monoclonal antibody therapy in postpartum women with neurological conditions. Ann Clin Transl Neurol. 2023;10(11):2053-2064. doi:10.1002/acn3.51893
  43. ↑ Larkin KL, Saboo US, Comer GM, et al. Use of intravitreal rituximab for treatment of vitreoretinal lymphoma. Br J Ophthalmol. 2014;98(1):99-103. doi:10.1136/bjophthalmol-2013-304043
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