Reader response: Pregnancy decision making in women with multiple sclerosis treated with natalizumab: I: Fetal risk II: Maternal risk
UndineProschmann, Neurologist, MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden
KatjaAkgün, Neurologist, MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden
TjalfZiemssen, Neurologist, MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden
Submitted March 01, 2018
Portaccio et al. describe a higher spontaneous abortion rate and lower birth weight and length. [1] They found that the risk of relapses during pregnancy was lower during a shortened washout period of natalizumab (NAT) and the risk of postpartum relapses was reduced under early resumption of NAT directly after delivery. [1,2]
We recently demonstrated that NAT can pass the placental barrier in mothers treated during whole pregnancy with NAT and that NAT is transferred into breastmilk. [3] Hematological alterations occurred in some newborns with a possible association to NAT treatment during the third trimester. [3] The risks of disease rebound after treatment interruption and the risks associated with treatment continuation during pregnancy and lactation must be assessed individually. This will allow a comprehensive decision about continuation of NAT during pregnancy. In our opinion, treatment cessation in the third trimester does not make sense as disease activity will return around delivery. NAT treatment seems to be crucial during lactation after delivery to avoid postpartum disease exacerbation. [4] Current data demonstrate the need for further investigation about the effects of NAT during pregnancy and lactation. Future studies should include pharmaco-kinetic and -dynamic parameters. [5]
Portaccio E, Moiola L, Martinelle V, et al. Pregnancy decision-making in women with multiple slcerosis treated with natalizumab: I: Fetal risks. Neurology 2018; 90:e823-e831.
Portaccio E, Moiola L, Martinelle V, et al. Pregnancy decision-making in women with multiple slcerosis treated with natalizumab: II: Maternal risks. Neurology 2018; 90:e832-e839.
Proschmann U, Thomas K, Thiel S, et al. Natalizumab during pregnancy and lactation. Mult Scler 2017; doi: 10.1177/1352458517728813.
Confavreux C, Hutchinson M, Hours MM, et al. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med 1998; 339: 285-291.
Sehr T, Proschmann U, Thomas K, et al. New insights into pharmacokinetics and pharmocodynamics of natalizumab treatment for patients with multiple sclerosis, obtained from clinical and in vitro studies. J Neuroinflammation 2016; 13:164.
Portaccio et al. describe a higher spontaneous abortion rate and lower birth weight and length. [1] They found that the risk of relapses during pregnancy was lower during a shortened washout period of natalizumab (NAT) and the risk of postpartum relapses was reduced under early resumption of NAT directly after delivery. [1,2]
We recently demonstrated that NAT can pass the placental barrier in mothers treated during whole pregnancy with NAT and that NAT is transferred into breastmilk. [3] Hematological alterations occurred in some newborns with a possible association to NAT treatment during the third trimester. [3] The risks of disease rebound after treatment interruption and the risks associated with treatment continuation during pregnancy and lactation must be assessed individually. This will allow a comprehensive decision about continuation of NAT during pregnancy. In our opinion, treatment cessation in the third trimester does not make sense as disease activity will return around delivery. NAT treatment seems to be crucial during lactation after delivery to avoid postpartum disease exacerbation. [4] Current data demonstrate the need for further investigation about the effects of NAT during pregnancy and lactation. Future studies should include pharmaco-kinetic and -dynamic parameters. [5]
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