{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:42:11Z","timestamp":1792550531240,"version":"4.5.0"},"reference-count":18,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:p>Ocrelizumab (OCR) is an IgG1 humanized monoclonal antibody directed against CD20. Due to its B-cell\u2013depleting ability, it is used in the treatment of multiple sclerosis, a disease that affects women of childbearing age. Although OCR use is not recommended in pregnancy, in utero exposure has occurred and resulted in normal to absent B cells at birth. Although this has been reported, longitudinal follow-up to determine whether B-cell reconstitution and function remain intact is lacking. Here, we present longitudinal follow-up of a neonate in which in utero OCR exposure resulted in B-cell depletion at birth. B-cell reconstitution occurred at age 4\u00a0months, with normal production of immunoglobulins and responses to vaccines noted at age 1\u00a0year. Awareness among pediatricians and neurologists regarding the effects of anti-CD20 therapies on the developing fetus and neonate may be lacking. An absence of B cells at birth should raise concern and be followed closely, as humoral immunity is an essential mechanism of passive and active immunity against infection throughout the lifetime. Recognition of patients exposed to anti-CD20 therapies during pregnancy allows for early detection and referral to an immunologist.<\/jats:p>","DOI":"10.1542\/peds.2025-070891","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:02:47Z","timestamp":1755216167000},"source":"Crossref","is-referenced-by-count":4,"title":["Ocrelizumab-Induced B-Cell Depletion in a Newborn"],"prefix":"10.1542","volume":"156","author":[{"given":"Maria A.","family":"Sacta","sequence":"first","affiliation":[{"name":"1Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kira","family":"Jacobs","sequence":"additional","affiliation":[{"name":"1Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"2University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Sun","sequence":"additional","affiliation":[{"name":"1Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhee","family":"Lee","sequence":"additional","affiliation":[{"name":"1Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"issue":"3","key":"2026050605421547400_r1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s40265-024-02011-w","article-title":"Drugs targeting CD20 in multiple sclerosis: pharmacology, efficacy, safety, and tolerability","volume":"84","author":"Carlson","year":"2024","journal-title":"Drugs."},{"key":"2026050605421547400_r2","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/B978-0-323-62539-5.00046-1","volume-title":"Braddom\u2019s Physical Medicine and Rehabilitation","author":"Narayan","year":"2021","edition":"6th ed"},{"key":"2026050605421547400_r3","doi-asserted-by":"crossref","first-page":"102398","DOI":"10.1016\/j.msard.2020.102398","article-title":"Ocrelizumab exposure in the second trimester of pregnancy without neonatal B-cell depletion","volume":"45","author":"Rolfes","year":"2020","journal-title":"Mult Scler Relat Disord."},{"issue":"1","key":"2026050605421547400_r4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.neurol.2015.10.006","article-title":"Epidemiology of multiple sclerosis","volume":"172","author":"Leray","year":"2016","journal-title":"Rev Neurol (Paris)."},{"issue":"1","key":"2026050605421547400_r5","doi-asserted-by":"crossref","first-page":"e200349","DOI":"10.1212\/NXI.0000000000200349","article-title":"Pregnancy and infant outcomes in women with multiple sclerosis treated with ocrelizumab","volume":"12","author":"Vukusic","year":"2025","journal-title":"Neurol Neuroimmunol Neuroinflamm."},{"issue":"1","key":"2026050605421547400_r6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1136\/pn-2022-003426","article-title":"Anti-CD20 therapies in pregnancy and breast feeding: a review and ABN guidelines","volume":"23","author":"Dobson","year":"2023","journal-title":"Pract Neurol."},{"key":"2026050605421547400_r7","article-title":"Pregnancy outcomes in patients treated with ocrelizumab","volume-title":"Medically.","author":"Bove","year":"2000"},{"issue":"7)(suppl 1","key":"2026050605421547400_r8","doi-asserted-by":"crossref","first-page":"5126","DOI":"10.1212\/WNL.0000000000205585","article-title":"Pregnancy and infant outcomes in females receiving ocrelizumab for the treatment of multiple sclerosis: analysis of over 3,000 pregnancies to date (S7.004)","volume":"102","author":"Bove","year":"2024","journal-title":"Neurology."},{"issue":"3","key":"2026050605421547400_r9","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/WCO.0000000000000922","article-title":"Use of disease-modifying drugs during pregnancy and breastfeeding","volume":"34","author":"Dobson","year":"2021","journal-title":"Curr Opin Neurol."},{"issue":"4","key":"2026050605421547400_r10","doi-asserted-by":"crossref","first-page":"e200264","DOI":"10.1212\/NXI.0000000000200264","article-title":"Neonatal B-cell levels and infant health in newborns potentially exposed to anti-CD20 monoclonal antibodies during pregnancy or lactation","volume":"11","author":"Schwake","year":"2024","journal-title":"Neurol Neuroimmunol Neuroinflamm."},{"issue":"1","key":"2026050605421547400_r11","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1038\/ajg.2008.71","article-title":"Placental transport of immunoglobulins: a clinical review for gastroenterologists who prescribe therapeutic monoclonal antibodies to women during conception and pregnancy","volume":"104","author":"Kane","year":"2009","journal-title":"Am J Gastroenterol."},{"issue":"1","key":"2026050605421547400_r12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1080\/21556660.2020.1721507","article-title":"Pregnancy-related issues in women with multiple sclerosis: an evidence-based review with practical recommendations","volume":"9","author":"Caniba\u00f1o","year":"2020","journal-title":"J Drug Assess."},{"key":"2026050605421547400_r13","article-title":"Invitae primary immunodeficiency panel","author":"Invitae"},{"issue":"3","key":"2026050605421547400_r14","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.immuni.2017.03.009","article-title":"Protecting the newborn and young infant from infectious diseases: lessons from immune ontogeny","volume":"46","author":"Kollmann","year":"2017","journal-title":"Immunity."},{"key":"2026050605421547400_r15","doi-asserted-by":"crossref","first-page":"103963","DOI":"10.1016\/j.msard.2022.103963","article-title":"Ocrelizumab during pregnancy and lactation: rationale and design of the MINORE and SOPRANINO studies in women with MS and their infants","volume":"64","author":"Bove","year":"2022","journal-title":"Mult Scler Relat Disord."},{"key":"2026050605421547400_r16","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/B978-0-323-40181-4.00102-X","volume-title":"Principles and Practice of Pediatric Infectious Diseases","author":"Adderson","year":"2018","edition":"5th 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