2023 American Academy of Neurology Abstract Website

Objective:

Evaluation for B-cell abnormalities in breastfed infants of mothers with multiple sclerosis (MS) who are on anti-CD20 therapies (rituximab, ocrelizumab, ofatumumab).

Background:

Patients with MS are at high risk of relapses in the postpartum period. Breastfeeding has been demonstrated to have some protective effect against postpartum relapses. However, data in regard to safety of most MS disease modifying therapies in breastfeeding is poorly established, leading to a decision between either early reinitiation of DMT postpartum versus breastfeeding.

Design/Methods:

We retrospectively evaluated 7 patients in our practice at the Rocky Mountain MS Center at the University of Colorado who had breastfed their infants on anti-CD20 therapies. These infants had a CBC and B-cell panel checked through their pediatricians as standard of care after treatment with anti-CD20 postpartum.

Results:

In all seven of these infants, there were no abnormalities found in either their CD19 or CD20 cell counts. The average age of the mothers with MS was 35.4 years. Typically, B-cell depleting agents were resumed between 1-6 months postpartum. The B-cell panels were checked between 2-12 weeks after their mother had received their infusion (rituximab, ocrelizumab) or 2 weeks after an injection (ofatumumab).

Conclusions:

In our small retrospective case series, we do not identify any B-cell abnormalities in breastfed infants whose mothers are receiving antiCD20 therapies early in the postpartum period for treatment of multiple sclerosis. Additional patients will likely be added to this case series before presentation as well as further details about the subjects. This data provides additional safety information to this treatment strategy for the infant while maintaining the mother with highly effective immunotherapy treatments for multiple sclerosis.