What is the best time to stop natalizumab in patients with active RRMS planning pregnancy?
ECTRIMS Online Library. Demortière S. 09/12/19; 279141; P781
Sarah Demortière
Sarah Demortière

Abstract: P781

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Pregnancy in MS

S. Demortiere, A. Rico, C. Boutiere, A. Maarouf, J. Pelletier, B. Audoin

Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France

Background: Planning pregnancy in women with active RRMS raises a difficult and conflicting medical ethical decision process because limitation of antenatal exposure to treatment implicates therapeutic withdrawn and potential disease reactivation.
Objective: To compare benefices and risks of two therapeutic strategies for women with active RRMS planning pregnancy, one consisting in maintaining natalizumab until conception and one until the end of first trimester.
Methods: At university hospital of Marseille, standardized therapeutic strategy for women with active RRMS planning pregnancy was initiated in 2014. In case of anti-JC virus antibody index under 1.5, natalizumab was recommended until the end of the first trimester ('secured first trimester'). When patients refused to continue natalizumab during pregnancy, maintenance until conception was advised ('secured conception'). Relapses and disability progression during pregnancy were notified. Predictors of disease activity were assessed through stepwise multivariable logistic regression models. Spontaneous abortions (SA), birth deficiencies (BD) and morphological measures of newborns were prospectively recorded.
Results: 46 pregnancies were prospectively followed (30 with 'secured first trimester' and 16 with 'secured conception'). Clinical characteristics before pregnancy were similar between the two groups. 3 SA occurred in the group 'secured conception' and 2 in the group 'secured first trimester'. One major BD occurred in the group 'secured conception'. No newborn showed abnormal morphological measures. Proportion of patients with relapse during pregnancy was lower in the group 'secured first trimester' compared to the group 'secured conception' (3.6% vs 38.5%, p< 0.005). Only time when natalizumab was stopped (conception vs end of first trimester) (p< 0.005; β= 0.25) was associated with relapse during pregnancy in the model. The proportion of patients with disability progression during pregnancy was lower in the group 'secured first trimester' vs 'secured conception' (3.6% vs 30.8%, p< 0.05). Only time when natalizumab was stopped (p< 0.05; β= 0.19) were associated with disability progression during pregnancy.
Conclusions: Maintenance of natalizumab until the end of the first trimester dramatically reduces the risk of disease reactivation during pregnancy in women with active RRMS. This strategy must be carefully discussed with the mother due to lack of comprehensive data on fetal safety.
Disclosure: The authors have nothing to disclose.

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