{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:25:14Z","timestamp":1790270714681,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:00Z","timestamp":1658707200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009471","name":"EkstraStiftelsen Helse og Rehabilitering","doi-asserted-by":"publisher","award":["2021\/FO347349"],"award-info":[{"award-number":["2021\/FO347349"]}],"id":[{"id":"10.13039\/100009471","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>There are limited data on the safety of breast feeding during rituximab therapy. Our objective is to determine exposure from breast feeding and biological effects of rituximab in breastfed infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In our case series of six mother\u2013infant pairs, the nursing mothers with relapsing-remitting multiple sclerosis received rituximab during breast feeding. As part of clinical follow-up, six serial breast milk samples, and blood samples from both mothers and infants, were collected and analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median average rituximab concentration (C<jats:sub>avg<\/jats:sub>) in breast milk was 0.04\u2009\u00b5g\/mL and the estimated relative infant dose (RID) was 0.07%. The highest measured concentration of rituximab in the breast milk samples was 0.25\u2009\u00b5g\/mL, giving an estimated RID of 0.26%.<\/jats:p><jats:p>All infant serum rituximab concentrations were below 0.01\u2009\u00b5g\/mL. The CD19 +B\u2009cell count values were within the 10th\u2013 90th percentiles of reported normal ranges in healthy infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found minimal transfer of rituximab into breast milk and could not reliably detect levels of rituximab in infant serum. B cell counts in infants were unaffected.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2022-329545","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T17:20:42Z","timestamp":1658769642000},"page":"38-41","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Safety of breast feeding during rituximab treatment in multiple sclerosis"],"prefix":"10.1136","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2200-1525","authenticated-orcid":false,"given":"Brit Ellen","family":"R\u00f8d","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5294-2866","authenticated-orcid":false,"given":"\u00d8ivind","family":"Torkildsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0980-510X","authenticated-orcid":false,"given":"Kjell-Morten","family":"Myhr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8675-4433","authenticated-orcid":false,"given":"Lars","family":"B\u00f8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7645-7686","authenticated-orcid":false,"given":"Stig","family":"Wergeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,25]]},"reference":[{"key":"2023051801102379000_94.1.38.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2008.10.004"},{"key":"2023051801102379000_94.1.38.2","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1001\/jamaneurol.2017.4011","article-title":"Comparative effectiveness of rituximab and other initial treatment choices for multiple sclerosis","volume":"75","author":"Granqvist","year":"2018","journal-title":"JAMA Neurol"},{"key":"2023051801102379000_94.1.38.3","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awh152"},{"key":"2023051801102379000_94.1.38.4","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1001\/jamaneurol.2019.4173","article-title":"Association between breastfeeding and postpartum multiple sclerosis relapses: a systematic review and meta-analysis","volume":"77","author":"Krysko","year":"2020","journal-title":"JAMA Neurol"},{"key":"2023051801102379000_94.1.38.5","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008213"},{"key":"2023051801102379000_94.1.38.6","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000000637","article-title":"Minimal breast milk transfer of rituximab, a monoclonal antibody used in neurological conditions","volume":"7","author":"Krysko","year":"2020","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2023051801102379000_94.1.38.7","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kex039"},{"key":"2023051801102379000_94.1.38.8","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s40744-021-00313-z","article-title":"Rituximab and canakinumab use during lactation: no detectable serum levels in breastfed infants","volume":"8","author":"Bosshard","year":"2021","journal-title":"Rheumatol Ther"},{"key":"2023051801102379000_94.1.38.9","doi-asserted-by":"publisher","DOI":"10.1177\/089033402237904"},{"key":"2023051801102379000_94.1.38.10","article-title":"Infant drug exposure via breast milk","author":"Verstegen","year":"2020","journal-title":"Br J Clin Pharmacol"},{"key":"2023051801102379000_94.1.38.11","unstructured":"Bennett PN . Drugs and human lactation: a comprehensive guide to the content and consequences of drugs, micronutrients, radiopharmaceuticals and environmental and occupational chemicals in human milk. 2nd ed. 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