Disease Activity During Pregnancy and Postpartum in Women With Multiple Sclerosis Treated With Ocrelizumab or Rituximab Before Pregnancy.
- 1Department of Neurology, St. Josef-Hospital - Katholisches Klinikum Bochum, Ruhr University Bochum, Germany.
- 2Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-Universität Düsseldorf, Germany; and.
- 3Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany.
Abstract
Background and objectives
Preliminary data suggest sustained disease control with ocrelizumab (OCR) or rituximab (RTX) in women with multiple sclerosis (MS) after pregnancy suspension; however, the influence of washout duration and cumulative dosing remains unknown. This study investigates disease activity during and after pregnancy in women with relapsing-remitting MS treated with OCR/RTX before pregnancy.Methods
In this cohort study, pregnancies of women treated with OCR/RTX documented in the German MS and Pregnancy Registry were stratified by timing of last infusion (≥ or <4 months to last menstrual period [LMP]) and number of cycles (≥ or <2 cycles). Relapses treated with high-dose glucocorticosteroids were analyzed, as was persistent disability (following a relapse) at 1-year postpartum, defined as a ≥2.0-point increase in Expanded Disability Status Scale (EDSS) or new/worsening ambulatory impairment (Severe Relapse Disability Composite Score [SRDCS]).Results
Of 294 pregnancies among 275 women, only 28.6% (n = 84) suspended OCR/RTX ≥4 months before LMP and most (79.3% [n = 233]) received ≥2 cycles. Relapses during pregnancy (2.0%) and within 12 months postpartum (8.5%) were rare. Four women (1.6%) reached the SRDCS postpartum. Neither the time of last infusion nor the number of cycles was associated with a higher relapse risk during pregnancy (time between OCR/RTX and LMP: <4 months adjusted OR: 0.60, CI: 0.09-5.02, p value: 0.60; number of cycles: <2 cycles adjusted OR: 2.23, CI: 0.34-15.5, p value: 0.39) or postpartum (time between OCR/RTX and LMP: <4 months adjusted OR: 0.62, CI: 0.23-1.77, p value: 0.36; number of cycles: <2 cycles adjusted OR: 0.64, CI: 0.16-2.03, p value: 0.48, time of anti-CD20 antibody restart postpartum: >6 weeks adjusted OR: 1.15, CI: 0.37-4.11, p value: 0.82) or with reaching the SRDCS or EDSS worsening postpartum. In women receiving ≥2 cycles and interrupting treatment <4 months before LMP, numerically fewer relapses during pregnancy could be observed (1/163: 0.6% vs 5/131: 3.8%, p value: 0.09).Discussion
Relapses and disability during and after pregnancy after OCR/RTX interruption are rare and independent of timing and number of cycles. However, potential differences may not be detectable due to the low number of events and should be evaluated in larger studies. In addition, the applicability to ofatumumab, given its different dosing interval, remains unclear.
Related
- Rituximab and Ocrelizumab in Multiple Sclerosis: Does Comparative Evidence Redefine Anti-CD20 Therapy?
- Predicting postpartum diastasis recti abdominis using early-pregnancy abdominal wall ultrasound radiomics
- Superficial Vein Thrombosis During Pregnancy and Postpartum—Findings From the French Multicenter Cohort “ HEMOTHEPP ” Study
- Vitamin K2 ameliorates pregnancy‐ and lactation‐associated osteopenia and postpartum depression
- Successful Postpartum CAR T-cell Salvage Therapy for Primary Mediastinal Large B-cell Lymphoma with Residual Disease after R-CHOP During Pregnancy
BibTeX
@article{bast2026disease,
title = {{Disease Activity During Pregnancy and Postpartum in Women With Multiple Sclerosis Treated With Ocrelizumab or Rituximab Before Pregnancy.}},
author = {Nadine Bast and Karen Dost-Kovalsky and Sabrina Haben and Laura Witt and Ralf Gold and Sandra Thiel and Kerstin Hellwig},
journal = {Neurology(R) neuroimmunology \& neuroinflammation},
year = {2026},
month = oct,
doi = {10.1212/nxi.0000000000200670},
url = {https://europepmc.org/article/MED/42854176},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Disease Activity During Pregnancy and Postpartum in Women With Multiple Sclerosis Treated With Ocrelizumab or Rituximab Before Pregnancy.
AU - Nadine Bast
AU - Karen Dost-Kovalsky
AU - Sabrina Haben
AU - Laura Witt
AU - Ralf Gold
AU - Sandra Thiel
AU - Kerstin Hellwig
PY - 2026
DA - 2026/10/09
JO - Neurology(R) neuroimmunology & neuroinflammation
DO - 10.1212/nxi.0000000000200670
UR - https://europepmc.org/article/MED/42854176
AB - Background and objectives Preliminary data suggest sustained disease control with ocrelizumab (OCR) or rituximab (RTX) in women with multiple sclerosis (MS) after pregnancy suspension; however, the influence of washout duration and cumulative dosing remains unknown. This study investigates disease activity during and after pregnancy in women with relapsing-remitting MS treated with OCR/RTX before pregnancy.Methods In this cohort study, pregnancies of women treated with OCR/RTX documented in the German MS and Pregnancy Registry were stratified by timing of last infusion (≥ or <4 months to last menstrual period [LMP]) and number of cycles (≥ or <2 cycles). Relapses treated with high-dose glucocorticosteroids were analyzed, as was persistent disability (following a relapse) at 1-year postpartum, defined as a ≥2.0-point increase in Expanded Disability Status Scale (EDSS) or new/worsening ambulatory impairment (Severe Relapse Disability Composite Score [SRDCS]).Results Of 294 pregnancies among 275 women, only 28.6% (n = 84) suspended OCR/RTX ≥4 months before LMP and most (79.3% [n = 233]) received ≥2 cycles. Relapses during pregnancy (2.0%) and within 12 months postpartum (8.5%) were rare. Four women (1.6%) reached the SRDCS postpartum. Neither the time of last infusion nor the number of cycles was associated with a higher relapse risk during pregnancy (time between OCR/RTX and LMP: <4 months adjusted OR: 0.60, CI: 0.09-5.02, p value: 0.60; number of cycles: <2 cycles adjusted OR: 2.23, CI: 0.34-15.5, p value: 0.39) or postpartum (time between OCR/RTX and LMP: <4 months adjusted OR: 0.62, CI: 0.23-1.77, p value: 0.36; number of cycles: <2 cycles adjusted OR: 0.64, CI: 0.16-2.03, p value: 0.48, time of anti-CD20 antibody restart postpartum: >6 weeks adjusted OR: 1.15, CI: 0.37-4.11, p value: 0.82) or with reaching the SRDCS or EDSS worsening postpartum. In women receiving ≥2 cycles and interrupting treatment <4 months before LMP, numerically fewer relapses during pregnancy could be observed (1/163: 0.6% vs 5/131: 3.8%, p value: 0.09).Discussion Relapses and disability during and after pregnancy after OCR/RTX interruption are rare and independent of timing and number of cycles. However, potential differences may not be detectable due to the low number of events and should be evaluated in larger studies. In addition, the applicability to ofatumumab, given its different dosing interval, remains unclear.
SN - 2332-7812
ER -