A new evidence review presents Association of British Neurologists guidelines for the use of Anti-CD20 therapies for women of childbearing age, concluding that it is safe to conceive and breastfeed whilst taking anti-CD20 therapy.
Anti-CD20 therapies, which act through B cell depletion, are increasingly used to treat neurological diseases, but are unlicensed for use in pregnancy. In the absence of guidelines, many patients of childbearing age have been advised to stop treatments prior to trying to conceive due to perceived risk to the fetus. This review examined observational and biological evidence and concludes that it is safe to conceive during anti-CD20 therapy, that women should not be denied clinically indicated treatment during pregnancy, and that anti-CD20 therapies can be safely given whilst breastfeeding.
The authors made specific recommendations that women should be counselled regarding live vaccinations for newborns, and that women receiving regular ocrelizumab for multiple sclerosis should preferably wait three months before trying to conceive. The review concludes that it is important to make time to discuss treatments with women of childbearing age to help them choose their most suitable treatment, and that all outcomes should be monitored in pregnancy registries.
Lead author Ruth Dobson said: “This study uses existing evidence to inform clinically meaningful ABN guidelines that will hopefully enable more informed discussions about the use of these treatments around pregnancy, balancing risks to mother from unnecessarily stopping treatments with risks to the baby from potential exposure.”
Dobson R, Rog D, Ovadia C, Murray K, Hughes S, Ford HL, Pearson OR, White S, Bonham N, Mathews J, Nelson-Piercy C, Brex P. Anti-CD20 therapies in pregnancy and breast feeding: a review and ABN guidelines. Pract Neurol. 2022 Jul 8:pn-2022-003426. doi: 10.1136/pn-2022-003426. Epub ahead of print. PMID: 35803727.