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Natalizumab has been associated with return and rebound of multiple sclerosis (MS) disease activity during pregnancy, in part due to its relatively short biologic effect by blocking VLA-4 adhesion and trafficking (NEJM JW Neurol Feb 16, 2018 and Neurology 2018; 90:e823). Anti-CD20 therapies have a longer biologic effect by B-cell depletion that continues after therapy discontinuation. In this study, investigators retrospectively compared disease activity in 45 women who suspended natalizumab at the end of the first trimester and 36 women (with 37 pregnancies) on infused anti-CD20 therapy (rituximab or ocrelizumab) who suspending treatment in the year prior to conception.
During pregnancy, 7% of women on natalizumab relapsed versus 3% of wome…