Anti-CD20 monoclonal antibody therapy in postpartum women with neurological conditions.
Ann Clin Transl Neurol
OBJECTIVE: Postpartum, patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) have increased risk for disease activity. Anti-CD20 IgG1 monoclonal antibodies (mAb) are increasingly used as disease-modifying therapies (DMTs). Patients may wish to both breastfeed and resume DMT postpartum. This study aimed to determine the transfer of anti-CD20 IgG1 mAbs, ocrelizumab, and rituximab (OCR/RTX), into mature breastmilk and describe maternal and infant outcomes.
METHODS: Fifty-seven cis-women receiving OCR/RTX after 59 pregnancies and their infants were enrolled and followed up to 12M postpartum or 90 days post-infusion. Breastmilk was collected pre-infusion and serially up to 90 days and assayed for mAb concentration. Medical records and patients' questionnaire responses were obtained to assess neurologic, breastfeeding, and infant development outcomes.
RESULTS: The median average concentration of mAb in breastmilk was low (OCR: 0.08 μg/mL, range 0.05-0.4; RTX: 0.03 μg/mL, range 0.005-0.3). Concentration peaked 1-7 days post-infusion in most (77%) and was nearly undetectable after 90 days. Median average relative infant dose was 0.05) infants; neither did the proportion with normal development (breastfed: 37/41, non-breastfed: 11/13; p > 0.05). After postpartum infusion, two mothers experienced a clinical relapse.
INTERPRETATION: These confirm minimal transfer of mAb into breastmilk. Anti-CD20 mAb therapy stabilizes MS activity before conception to the postpartum period, and postpartum treatments appears to be safe and well-tolerated for both mother and infant.
Women & Children
Neurosciences (Brain & Spine)
Obstetrics & Gynecology
Anderson, Annika; Rowles, William; Poole, Shane; Balan, Ayushi; Bevan, Carolyn; Brandstadter, Rachel; Ciplea, Andrea I; Cooper, Joanna; Fabian, Michelle; Hale, Thomas W; Jacobs, Dina; Kakara, Mihir; Krysko, Kristen M; Longbrake, Erin E; Marcus, Jacqueline; Repovic, Pavle; Riley, Claire S; Romeo, Andrew R; Rutatangwa, Alice; West, Timothy; Hellwig, Kerstin; LaHue, Sara C; and Bove, Riley, "Anti-CD20 monoclonal antibody therapy in postpartum women with neurological conditions." (2023). Articles, Abstracts, and Reports. 7879.