怀孕期间暂停纳塔利祖马布的高活跃多发性硬化症妇女的疾病演变与怀孕前的瑞图西马布/奥克雷祖马布
Sarah Demortiere1, Adil Maarouf1, Audrey Rico1
1From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France.
Neurology(R) neuroimmunology & neuroinflammation
|August 7, 2023
概括
在患有多发性硬化症 (MS) 的妇女怀孕前暂停服用瑞图西马布 (RTX),可以防止在怀孕期间和怀孕后疾病的重新激活. 停止纳塔利祖马布 (NTZ) 与复发风险增加有关,使RTX成为预期母亲更舒适的选择.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 生殖医学 生殖医学
背景情况:
- 妇女患有高度活跃的多发性硬化症 (MS) 给怀孕计划带来了挑战.
- 怀孕前的瑞图西马布 (RTX) 暂停与低的疾病再激活有关.
- 暂停RTX和纳塔利祖马布 (NTZ) 之间的疾病重新激活的比较风险需要澄清.
研究的目的:
- 在怀孕前暂停RTX/ocrelizumab (OCR) 的MS妇女中比较疾病再激活风险,与在怀孕期间暂停NTZ的妇女相比.
- 评估与这些治疗策略相关的怀孕结果和产后疾病活动.
主要方法:
- 在怀孕期间和分娩后一年,对MS患者进行了回顾性研究.
- 妇女在怀孕第一季度暂停NTZ和在怀孕前一年暂停RTX/OCR之间的结果比较.
主要成果:
- 在RTX/OCR暂停组 (n=33) 中,怀孕期间或之后没有复发.
- 暂停NTZ组 (n=42) 在21.4%的患者中经历了分娩后复发,MRI损伤负担更高,EDSS进展.
- 两组之间没有观察到流产率或重大发育不良的显著差异.
结论:
- 在怀孕之前暂停RTX/OCR与怀孕期间和之后高活性MS的妇女没有疾病的重新激活有关.
- 怀孕早期的纳塔利祖马布 (NTZ) 暂停与疾病的重新激活有关.
- 对于MS患者计划怀孕的妇女来说,过渡到RTX/OCR或继续NTZ直到34周是可行的选择,RTX/OCR提供更大的舒适性和减少婴儿暴露.
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