RT Journal Article
SR Electronic
T1 Anti-CD20 therapies and pregnancy in neuroimmunologic disorders
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e913
DO 10.1212/NXI.0000000000000913
VO 8
IS 1
A1 Tania Kümpfel
A1 Sandra Thiel
A1 Ingrid Meinl
A1 Andrea I. Ciplea
A1 Antonios Bayas
A1 Frank Hoffmann
A1 Ulrich Hofstadt-van Oy
A1 Muna Hoshi
A1 Jakob Kluge
A1 Marius Ringelstein
A1 Orhan Aktas
A1 Muriel Stoppe
A1 Annette Walter
A1 Martin S. Weber
A1 Ilya Ayzenberg
A1 Kerstin Hellwig
YR 2021
UL http://nn.neurology.org/content/8/1/e913.abstract
AB Objective To report pregnancy outcomes and disease activity (DA) in women with MS, neuromyelitis optica spectrum disorders (NMOSDs), and other neuroimmunologic diseases (ONID) after treatment with rituximab (RTX)/ocrelizumab (OCR) 12 months before or during pregnancy.Methods Data were collected in the German MS and pregnancy registry and centers from the Neuromyelitis Optica Study Group. Sixty-eight known outcomes of 88 pregnancies from 81 women (64 MS, 10 NMOSD, and 7 ONID) were included and stratified in 3 exposure groups: >6M-group = RTX/OCR >6 but ≤12 months before the last menstrual period (LMP) (n = 8); <6M group = RTX/OCR <6 months before the LMP (n = 47); preg group = RTX/OCR after the LMP (n = 13).Results Pregnancy outcomes were similar between groups, but significantly more preterm births (9.8% vs 45%) occurred after exposure during pregnancy. Overall, 2 major congenital abnormalities (3.3%), both in the preg group, were observed. Three women had severe infections during pregnancy. All women with MS (35) and 12/13 women with NMOSD, RTX/OCR exposure before the LMP and known pregnancy outcomes after gestational week 22 were relapse free during pregnancy. Five of 29 (17.2%) women with relapsing-remitting MS (RRMS) and 1 of 12 (8.3%) with NMOSD and at least 6 months postpartum follow-up experienced a relapse postpartum. Duration of RTX/OCR and early retreatment but not detection of B-cells were possible predictors for postpartum relapses in patients with RRMS/NMOSD.Conclusions Although RTX/OCR might be an interesting option for women with RRMS/NMOSD who plan to become pregnant to control DA, more data on pregnancy outcomes and rare risks are needed.CA=congenital anomalies; DA=disease activity; DMT=disease-modifying therapy; EA=elective abortion; EDSS=Expanded Disability Status Scale; GW=gestational week; LMP=last menstrual period; mAb=monoclonal antibody; NEMOS=Neuromyelitis Optica Study Group; NMOSD=neuromyelitis optica spectrum disorder; OCR=ocrelizumab; ONID=other neuroimmunologic diseases; RRMS=relapsing-remitting MS; RTX=rituximab; SA=spontaneous abortion