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Natalizumab discontinuation and disease restart in pregnancy: a case series
L De Giglio1, C Gasperini, C Tortorella
1Department of Neurology and Psychiatry, "Sapienza" Unversity of Rome, Rome, Italy.
Background:
The humanized monoclonal alpha4-integrin antibody Natalizumab (NTZ) (Tysabri(©) , Biogen Idec, Cambridge, MA, USA) has shown to be effective in multiple sclerosis (MS) therapy; however, the interruption of the drug has been related to a disease restart. This risk has to be carefully considered in case of accidental or desired pregnancies.
Aim Of The Study:
To report the risk of disease restart in patients who interrupted NTZ because of pregnancy and discuss the implication of NTZ choice in female childbearing patients with MS.
Methods:
Clinical histories and MRI images of four pregnant women with MS who interrupted NTZ.
Results:
Despite pregnancy is usually related with disease stability, the cases presented here showed an abrupt increase of disability with high number of MRI lesions, some of them with a mass effect.
Conclusions:
We recommend that female patients on childbearing age must be informed before starting NTZ treatment of the risk of a return of disease activity when the drug is discontinued. The risk occurs even during pregnancy a condition that is considered as protective for women with MS.
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