Disease Activity During Pregnancy and Postpartum in Women With Multiple Sclerosis Treated With Ocrelizumab or Rituximab Before Pregnancy

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: 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.