Positive Safety Profile of Anti-CD20 Therapy During Postpartum in MS, NMOSD: Riley Bove, MD

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“When it comes to NMOSD, we don't really have a good sense of what factors may be protective, except for the treatments. It's important that we don't have too big of a time window in the postpartum period as well, where the patients are untreated.”

Riley Bove, MD, coauthored an oral presentation at the 2022 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, from October 26-28, in Amsterdam, Netherlands. The abstract focused on whether anti-CD20 IgG1 monoclonal antibodies (mABs) pose as a safety concern during lactation. To do so, investigators assessed the transfer of anti-CD20 IgG1 mAb into mature breastmilk and the outcomes up to 12 months (12M) after delivery for patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).¹

Bove, associate professor of neurology, University of California, San Francisco, and colleagues enrolled 57 women with MS or NMOSD across 12 MS Centers in Germany and the US between November 2017 and July 2021. The women then received 1-2 doses ocrelizumab (Ocrevus; Genentech) 300 or 600mg, or rituximab (Rituxan; Genentech) 500 or 1000mg, while breastfeeding, with breastmilk collected up to 90 days.

All told, the median average concentration of mAb in breastmilk was low at 0.18μg/mL (ocrelizumab, n=32) and 0.04μg/mL (rituximab, n=21). At 1 to 7 days post-infusion, the concentration peaked in most women (72%) and was almost undetectable at the 90 days post administration. The median average relative infant dose was 0.16% for ocrelizumab and 0.04% for rituximab.

In a recent interview with NeurologyLive^®, Bove discussed some of the takeaways from the presentation. She mentioned the unknowns about the postpartum period in patients with MS and NMOSD, including conversations about coming off therapy and other important considerations.

REFERENCES
1. Anderson A, Poole S, Rowles W et al. Anti-CD20 monoclonal antibody therapy after 59 pregnancies in women with neurological conditions: low breastmilk transfer and normal infant development in a multicenter cohort. Presented at: 2022 ECTRIMS Congress; October 26-28; Amsterdam, Netherlands. Abstract 0037