ArticleNeurology(R) neuroimmunology & neuroinflammation2020
Minimal breast milk transfer of rituximab, a monoclonal antibody used in neurological conditions.
Article in Neurology(R) neuroimmunology & neuroinflammation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 28 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Monoclonal Antibodies in Mothers' Milk and Infants: Ocrelizumab in Breastmilk
Prospective Evaluation of Emgality (Galcanezumab) in Breastmilk in Adult Women With Migraine
Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids.Rheumatology (Oxford, England) · 2023Guideline
- Transfer of monoclonal antibodies into breastmilk in neurologic and non-neurologic diseases.Neurology(R) neuroimmunology & neuroinflammation · 2020Pooled it
- Pregnancy and Neuromyelitis Optica Spectrum Disorder - Reciprocal Effects and Practical Recommendations: A Systematic Review.Frontiers in neurology · 2020Pooled it
- Monoclonal insulin autoimmune syndrome in pregnancy and postpartum.Endocrinology, diabetes & metabolism case reports · 2026Article
- Management of hairy cell leukaemia in pregnancy.Obstetric medicine · 2026Article
- Rituximab for autoimmune blistering diseases in pregnancy and children: a clinical review.International journal of women's dermatology · 2026Review
- Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability.JAMA network open · 2025Article
- Safety of Drugs in Breastfeeding Women With CKD.Kidney international reports · 2025Article
- A literature review of drug transport mechanisms during lactation.CPT: pharmacometrics & systems pharmacology · 2024Review
- Early postpartum treatment strategies and early postpartum relapses in women with active multiple sclerosis.Journal of neurology, neurosurgery, and psychiatry · 2024Article
- Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management.Journal of neurology · 2024Review
- Anti-CD20 monoclonal antibody therapy in postpartum women with neurological conditions.Annals of clinical and translational neurology · 2023Article
- [Esclerosis multiple. Lactancia. Lactante. Planificacion familiar. Posparto. Tratamiento modificador de la enfermedad.]Revista de neurologia · 2023Review
- Anti-CD20 therapies in multiple sclerosis: From pathology to the clinic.Frontiers in immunology · 2023Review
- Safety of breast feeding during rituximab treatment in multiple sclerosis.Journal of neurology, neurosurgery, and psychiatry · 2022Article
- Use of B-Cell-Depleting Therapy in Women of Childbearing Potential With Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder.Neurology. Clinical practice · 2022Review
- Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know?Frontiers in neurology · 2022Review
- Successful Pregnancies in a Patient with Childhood-onset Steroid-dependent Nephrotic Syndrome during Rituximab Maintenance Therapy.Internal medicine (Tokyo, Japan) · 2021Article
- Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis.Neurology · 2021Article
- Vedolizumab Concentrations in Breast Milk: Results from a Prospective, Postmarketing, Milk-Only Lactation Study in Nursing Mothers with Inflammatory Bowel Disease.Clinical pharmacokinetics · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the transfer of rituximab, an anti-CD20 monoclonal antibody widely used for neurologic conditions, into mature breast milk.
methodsBreast milk samples were collected from 9 women with MS who received rituximab 500 or 1,000 mg intravenous once or twice while breastfeeding from November 2017 to April 2019. Serial breast milk samples were collected before infusion and at 8 hours, 24 hours, 7 days, and 18-21 days after rituximab infusion in 4 patients. Five additional patients provided 1-2 samples at various times after rituximab infusion.
resultsThe median average rituximab concentration in mature breast milk was low at 0.063 μg/mL (range 0.046-0.097) in the 4 patients with serial breast milk collection, with an estimated median absolute infant dose of 0.0094 mg/kg/d and a relative infant dose (RID) of 0.08% (range 0.06%-0.10%). Most patients had a maximum concentration at 1-7 days after infusion. The maximum concentration occurred in a woman with a single breast milk sample and was 0.29 μg/mL at 11 days postinfusion, which corresponds with an estimated RID of 0.33%. Rituximab concentration in milk was virtually undetectable by 90 days postinfusion.
conclusionsWe determined minimal transfer of rituximab into mature breast milk. The RID for rituximab was less than 0.4% and well below theoretically acceptable levels of less than 10%. Low oral bioavailability would probably also limit the absorption of rituximab by the newborn. In women with serious autoimmune neurologic conditions, monoclonal antibody therapy may afford an acceptable benefit to risk ratio, supporting both maternal treatment and breastfeeding.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.