Abstract
Multiple Sclerosis (MS) is an autoimmune neuroinflammatory disorder affecting the central nervous system (CNS). As it is mostly seen in women of childbearing age, treatment strategies prior to and during pregnancy are becoming major concerns. Furthermore, due to the postpartum activation and relapse of MS ( 1 Hughes SE Spelman T Gray OM Boz C Trojano M Lugaresi A et al. Predictors and dynamics of postpartum relapses in women with multiple sclerosis. Mult. Scler. J. 2014; 20: 739-746 Crossref PubMed Scopus (104) Google Scholar , 2 Vukusic S Hutchinson M Hours M Moreau T Cortinovis-Tourniaire P Adeleine P et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain J. Neurol. 2004; 127: 1353-1360 Crossref PubMed Scopus (432) Google Scholar , 3 Confavreux C Hutchinson M Hours MM Cortinovis-Tourniaire P Moreau T Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. N. Engl. J. Med. 1998; 339: 285-291 Crossref PubMed Scopus (1190) Google Scholar ), treatment strategies need modification. Novel therapeutics targeting CD20+ B cells are increasingly incorporated in MS due to better response and reduced Annualized Relapse Rate (ARR) ( 4 McCool R Wilson K Arber M Fleetwood K Toupin S Thom H et al. Systematic review and network meta-analysis comparing ocrelizumab with other treatments for relapsing multiple sclerosis. Mult. Scler. Relat. Disord. 2019; 29: 55-61 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 5 Alping P Frisell T Novakova L Islam-Jakobsson P Salzer J Björck A et al. Rituximab versus fingolimod after natalizumab in multiple sclerosis patients. Ann. Neurol. 2016; 79: 950-958 Crossref PubMed Scopus (146) Google Scholar , 6 Gelfand JM Cree BAC Hauser SL Ocrelizumab and other CD20+ B-cell-depleting therapies in multiple sclerosis. Neurotherapeut. J. Am. Soc. Exp. NeuroTherap. 2017; 14: 835-841 Crossref PubMed Scopus (81) Google Scholar ). However, there are safety concerns regarding their use in pregnancy, limiting their administration on a regular basis. This is a report of MS patients, who have conceived during Rituximab treatment.
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