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Journal article
Disease Activity in Pregnant and Postpartum Women With Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies
Neurology : neuroimmunology & neuroinflammation, Vol.11(6), e200328
2024
PMID: 39442037
Abstract
Background and Objectives
Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods.
Methods
We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods.
Results
A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02–0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01–0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03–0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20–0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50–1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10–0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38–0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06–0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26–0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse.
Discussion
Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family.
Classification of Evidence
This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.
Details
- Title
- Disease Activity in Pregnant and Postpartum Women With Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies
- Authors/Creators
- Wei Z Yeh - Monash UniversityAnneke Van Der Walt - Monash UniversityOlga G Skibina - Box Hill HospitalTomas Kalincik - The Royal Melbourne HospitalRaed Alroughani - Amiri HospitalAllan G Kermode - Murdoch University, Institute for Immunology and Infectious DiseasesMarzena J Fabis-Pedrini - Perron Institute for Neurological and Translational ScienceWilliam M Carroll - Monash UniversityJeannette Lechner-Scott - John Hunter HospitalCavit Boz - Monash UniversitySerkan Ozakbas - Monash UniversityKatherine Buzzard - The Royal Melbourne HospitalMario Habek - University of ZagrebNevin A John - Monash Medical CentreAlexandre Prat - Monash UniversityMarc Girard - Monash UniversityPierre Duquette - Université de MontréalSeyed Mohammad Baghbanian - Mazandaran University of Medical SciencesSuzanne Hodgkinson - Liverpool HospitalVincent Van Pesch - Monash UniversityGuy Laureys - Monash UniversityBarbara Willekens - Monash UniversityJulie Prevost - Monash UniversityMatteo Foschi - Ospedale "Santa Maria delle Croci" di RavennaKoen De Gans - Monash UniversityDana Horakova - Charles UniversityEva Kubala Havrdova - Monash UniversityRana Karabudak - Monash UniversityFrancesco Patti - University of CataniaPamela A Mccombe - Monash UniversityDavide Maimone - Monash UniversityAyse Altintas - Koç UniversityRadek Ampapa - Monash UniversityDaniele Spitaleri - Monash UniversityOliver H H GerlachMaria Jose Sa - Monash UniversityStella Hughes - Monash UniversityRiadh Gouider - Monash UniversitySaloua Mrabet - Monash UniversityRichard A Macdonell - Austin HealthRecai Turkoglu - Monash UniversityElisabetta Cartechini - Monash UniversityAbdullah Al-Asmi - Monash UniversityAysun Soysal - Monash UniversityJiwon Oh - St. Michael's HospitalErwan Muros-Le RouzicSabrina Guye - Monash UniversityNoemi Pasquarelli - Monash UniversityHelmut Butzkueven - Monash UniversityVilija G Jokubaitis - Monash UniversityMSBase Study Group
- Publication Details
- Neurology : neuroimmunology & neuroinflammation, Vol.11(6), e200328
- Publisher
- Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
- Identifiers
- 991005709870307891
- Copyright
- © 2024 The Author(s).
- Murdoch Affiliation
- Murdoch University
- Language
- English
- Resource Type
- Journal article
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