scholarly journals Use of B-Cell–Depleting Therapy in Women of Childbearing Potential With Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder

2022 ◽  
pp. 10.1212/CPJ.0000000000001147
Author(s):  
Alexandra Galati ◽  
Thomas McElrath ◽  
Riley Bove

AbstractPurposeof Review: There is considerable heterogeneity in the use of B cell depletion in women of childbearing age, likely driven at least in part by the discrepancy between the product labels and what is known about the physiology of IgG1, including breastmilk and placental transfer.Recent Findings:We provide practical considerations on the use of this medication class in women of childbearing potential. We discuss pre-pregnancy planning including vaccinations, safety of B cell depletion during pregnancy as well as postpartum considerations including breastfeeding.Summary:B cell depleting monoclonal antibodies have shown to be effective for pre-pregnancy and postpartum prevention of inflammatory activity in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). B cell depleting therapies are large IgG1 monoclonal antibodies which have minimal transfer across the placenta and into breastmilk. Consideration of risks and benefits of these therapies should be considered in counseling women planning pregnancy and postpartum.

2021 ◽  
pp. 577666
Author(s):  
Elia Sechi ◽  
Roberto Zarbo ◽  
Maria Angela Biancu ◽  
Paola Chessa ◽  
Maria Laura Idda ◽  
...  

2019 ◽  
Vol 50 (03) ◽  
pp. 193-196
Author(s):  
Markus Breu ◽  
Sarah Glatter ◽  
Romana Höftberger ◽  
Michael Freilinger ◽  
Karl Kircher ◽  
...  

AbstractB cell depletion with the anti-CD20-antibody rituximab is widely considered treatment of choice for long-term immunotherapy in aquaporin-4 (AQP4)-antibody positive neuromyelitis optica spectrum disorder (NMOSD). However, up to 30% of patients suffer from relapses despite complete B cell depletion. In these cases, the IL6 (interleukin-6)-receptor blocking antibody tocilizumab has been suggested as an alternative. We report two female adolescents with AQP4-antibody positive NMOSD who relapsed under rituximab treatment and clinically stabilized after switching to monthly administrations of tocilizumab. Our data suggest that early escalation of therapy with tocilizumab may lead to stabilization of disease activity in pediatric NMOSD patients who relapse under B cell depletion.


2021 ◽  
Vol 51 ◽  
pp. 102886
Author(s):  
Ricardo Alonso ◽  
Berenice Silva ◽  
Orlando Garcea ◽  
Patricio E. Correa Diaz ◽  
Giordani Rodrigues dos Passos ◽  
...  

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012754
Author(s):  
Joep Killestein ◽  
Menno M. Schoonheim ◽  
Rhonda R. Voskuhl

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