Evidence of disease activity during pregnancy and post-partum in MS patients treated with high-efficacy therapies

• Published in: Multiple sclerosis and related disorders 2024-05, Vol.85, p.105557-105557, Article 105557
• Main Authors: Sahloul, Oussama, Louapre, Céline, Beigneux, Ysoline, Lubetzki, Catherine, Maillart, Elisabeth, Roux, Thomas
• Format: Article
• Language: English
• Subjects: Anti-CD20; Fingolimod; Multiple sclerosis; Natalizumab; Pregnancy
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2024.105557

•Anti-CD20 are an efficient option to prevent MS reactivation during pregnancy.•Natalizumab if pursued until the end of the 2nd trimester is a reasonable alternative.•Fingolimod before pregnancy is associated with a higher MS reactivation risk. Multiple sclerosis (MS) predominantly affects women of childbearing age. Due to the risk of teratogenicity, women with active multiple sclerosis (MS) who require high-efficacy therapies (HET) may need to discontinue treatment during pregnancy. Fingolimod and Natalizumab withdrawal increases the risk of disease reactivation, a risk not commonly associated with anti-CD20 therapies. However, comparative data are limited during pregnancy and post-partum. Our aim was to compare evidence of disease activity during pregnancy and post-partum in women treated with HET (anti-CD20 therapies, Natalizumab or Fingolimod) before conception, whether or not exposed during pregnancy. In this single-center retrospective study, we included consecutive pregnancies of relapsing-remitting MS patients and classified them in three groups according to the last HET used before conception: « anti-CD20 » « Natalizumab (NTZ) » and « Fingolimod (FGD) ». The main outcome was annualized relapse rate (ARR) during pregnancy and post-partum. We included 66 pregnancies: 21, 24 and 21 in anti-CD20, NTZ and FGD groups respectively. Overall, mean ARR (SD) increased from 0.36 (0.6) during the preconception year to 0.60 (1.3) during pregnancy and to 1.03 (2.0) in the first 3 months post-partum. Mean ARR in anti-CD20 group (0.09 (0.3)) during pregnancy and the first 3 months post-partum was lower compared with NTZ (0.48 (0.6); p = 0,09) and FGD (1.50 (1.8); p = 0.001) groups. Proportion of pregnancies with radiological activity during pregnancy and post-partum in anti-CD20 group (5.2 %) was lower compared with NTZ (63.1 %; p < 0.001) and FGD (72.2 %; p < 0.001) groups. There was no significant difference in the evolution of EDSS score from conception to post-partum between each group (p = 0.75). Evidence of disease activity was significantly lower in patients exposed to anti-CD20 therapies before conception. This study suggests that use of anti-CD20 therapies is an efficient option to prevent disease reactivation during pregnancy and post-partum.