Ocrelizumab-Induced B-Cell Depletion in a Newborn

Area of Science:

• Immunology
• Neonatal Medicine
• Pharmacology

Background:

• Ocrelizumab (OCR), a CD20-targeting monoclonal antibody, is used for multiple sclerosis, a condition affecting women of childbearing age.
• While OCR is not recommended during pregnancy, in utero exposure can occur, leading to B-cell depletion in neonates.
• Longitudinal data on B-cell reconstitution and immune function following in utero OCR exposure are limited.

Purpose of the Study:

• To present the longitudinal follow-up of a neonate exposed to ocrelizumab in utero.
• To assess B-cell reconstitution, immunoglobulin production, and vaccine response in an infant with documented in utero anti-CD20 therapy exposure.

Main Methods:

• Case report detailing longitudinal follow-up of a single neonate.
• Monitoring of B-cell counts from birth.
• Assessment of immunoglobulin levels and vaccine responses at one year of age.

Main Results:

• The neonate exhibited B-cell depletion at birth following in utero ocrelizumab exposure.
• B-cell reconstitution was observed by 4 months of age.
• Normal immunoglobulin production and vaccine responses were confirmed at 1 year of age.

Conclusions:

• Infants exposed to ocrelizumab in utero can achieve B-cell reconstitution and maintain normal immune function.
• Increased awareness among healthcare providers regarding anti-CD20 therapies in pregnancy is crucial for proper infant management.
• Close monitoring of neonates with in utero anti-CD20 exposure is recommended to ensure adequate humoral immunity.