Pregnancy Outcomes in Neuromyelitis Optica Spectrum Disorder: A Meta-Analysis of Pharmacotherapeutic Agents
Parth Ladha1, Suban Amatya2, Yusuf Kagzi3, Rutvik Savaliya4, Sema Akkuş5, Jian Xu6, Dinesh Lulla7, Shitiz Sriwastava8
1BJ Government Medical College, Pune, 2Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal, 3University of Illinois College of Medicine, Peoria, 4GCS Medical College, Ahmedabad, India, 5Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 6Henry Ford Hopsital, Detroit, 7Valley Children's Healthcare and Hospital, 8UT Health Houston
Objective:
To analyze the evidence on outcomes of pregnancies in Neuromyelitis Optica Spectrum Disorder(NMOSD) treated with different pharmacotherapeutics.
Background:
Pregnancies with NMOSD present a complex scenario. Both the disease and pharmacological agents (PA) used in management have significant implications for maternal and fetal well-being.
Design/Methods:
A comprehensive analysis using different models, including a random-effects model, and separate analyses for specific drugs like rituximab, tocilizumab, and eculizumab was conducted. The analysis involved examining continuous variables, encompassing pregnancy age, full-term and preterm pregnancies, premature delivery, spontaneous abortion, elective termination with and without birth defects, stillbirth, and live births with birth defects. Additionally, meta-analysis was performed to assess pregnancy outcomes in NMOSD patients undergoing treatment with different PA. We excluded ravulizumab due to the limited number of studies.
Results:
In our meta-analysis of 31 studies investigating pregnancy outcomes in NMOSD treated with rituximab, tocilizumab, and eculizumab, we observed majority pregnancies resulted in full-term births (70.8%) with 19.5% preterm deliveries and 10.3% miscarriages. Ectopic pregnancies were rare (0.2%). Rituximab, tocilizumab, and eculizumab demonstrated varying rates of full-term births (67.6%, 63.1%, and 80.7%, respectively) and preterm deliveries (11.7%, 6.9%, and 39.4%, respectively). Birth defects were infrequent across all treatments(2.2% with rituximab, 1.9% with tocilizumab, and 0.1% with eculizumab). These findings underscore the overall safety of these medications during pregnancy in NMOSD, emphasizing the need for tailored management strategies and vigilant monitoring.
Conclusions:
Overall considerations from the study and existing guidelines help us conclude that although there is not enough data on the primary treatments of NMO in pregnancy and lactation, the existing literature supports informed decision-making based upon the risk-benefit ratio with careful monitoring of fetus and infants exposed to the medications.This highlights the need for more data to be gathered as NMOSD often affects females of childbearing age-group.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.