Disease activity in pregnancy and postpartum in women with MS who suspended rituximab and natalizumab.
Adult
Cohort Studies
Female
Humans
Immunologic Factors
/ administration & dosage
Multiple Sclerosis
/ drug therapy
Natalizumab
/ administration & dosage
Outcome Assessment, Health Care
Pregnancy
Pregnancy Complications
/ drug therapy
Puerperal Disorders
/ drug therapy
Recurrence
Registries
Rituximab
/ administration & dosage
Sweden
Time Factors
Journal
Neurology(R) neuroimmunology & neuroinflammation
ISSN: 2332-7812
Titre abrégé: Neurol Neuroimmunol Neuroinflamm
Pays: United States
ID NLM: 101636388
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
27
11
2019
accepted:
24
08
2020
entrez:
22
10
2020
pubmed:
23
10
2020
medline:
5
10
2021
Statut:
epublish
Résumé
To evaluate risks of disease reactivity during pregnancy and postpartum following rituximab (RTX) and natalizumab (NTZ) suspension in women with MS. An observational cohort study of all women with MS disease onset before childbirth between 2006 and 2017. Women were identified through the Swedish MS Registry, a nationwide clinical register, with substratification into 3 groups: women who suspended RTX and NTZ within 6 months before conception and women who were not treated with any disease-modifying treatment (DMT) within 1 year of conception. The primary outcome was the annualized relapse rate (ARR) during pregnancy and 1 year postpartum. We identified 2,386 women with MS onset before a live birth; of these, 76 women suspended RTX and 53 suspended NTZ, and 457 were untreated within 1 year before conception. In all women, regardless of the treatment type, the ARR declined from 0.05-0.04 prepregnancy to 0.03-0.02 during pregnancy, returning to prepregnancy rates at 3-6 months (0.05) postpartum. In the suspended cohort, 76% (98/129) of women resumed a DMT after delivery. The relapse rate 1 year postpartum was significantly higher in the suspended NTZ women compared with the suspended RTX women (adjusted rate ratio [aRR] 7.65, 95% CI 2.47-23.6) and was lower in the suspended RTX women compared with the untreated women (aRR 0.21, 95% CI 0.08-0.61). Disease reactivity during the postpartum period was lower among women with MS who suspended RTX before pregnancy, relative to those who suspended NTZ and untreated women. These findings suggest that RTX may exert long-acting effects on MS disease activity that encompass pregnancy and postpartum periods. This study provides Class IV evidence that in patients with MS who were on treatment before pregnancy, RTX reduces clinical disease activity compared with NTZ in the postpartum period.
Identifiants
pubmed: 33087582
pii: 7/6/e903
doi: 10.1212/NXI.0000000000000903
pmc: PMC7641107
pii:
doi:
Substances chimiques
Immunologic Factors
0
Natalizumab
0
Rituximab
4F4X42SYQ6
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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