Counselling and managing women with active Multiple Sclerosis (MS) during pregnancy and the postpartum period is a challenge. Alemtuzumab (ALZ) might be an option for patients with severe MS who desire pregnancy. However, data on relapse activity during and after pregnancy is scarce.
Our objective was to describe our experience with ALZ treatment prescribed in highly active MS women with a pregnancy desire.
From all ALZ treated women (n=62), patients starting treatment because of a pregnancy desire were selected. Demographic, clinical, and radiological data before and during ALZ treatment as well as during and after pregnancy were collected.
From 1st September 2019, thirteen patients were identified with a mean age at ALZ onset of 33.9 years (SD 5.5), median disease duration of 12.0 years (IQR 12.5). The median number of relapses 1 year prior to ALZ onset was 2.0 (IQR 2.0) and 6 out of 10 patients (60%) had Gd-enhancing lesions at baseline MRI (median of 4.5 lesions; IQR 8.3). Only one patient was treatment naïve prior to ALZ onset, 5 patients (38%) were receiving fingolimod, 3 patients (23.1%) injectable therapies, and 3 patients (23,1%) other monoclonal antibodies. As of 1st June 2020, 4 patients (30%) were still not pregnant, 8 patients (61.5%) have had a full-term pregnancy, and 1 patient (7.7%) was still pregnant. All 9 pregnant patients have received two cycles of ALZ with a median time from the last ALZ dose to pregnancy of 9 months (IQR 18). After 1-2 years ALZ treatment, and prior to the pregnancy, 4 out of 9 patients (44.4%) had at least one relapse and 3 (33.3%) patients had an active brain MRI either at 12 or 24 months after ALZ onset. During pregnancy, only 1 patient had a relapse during the first trimester. During the postpartum period, 2 out of 8 (25%) patients experienced a disease reactivation with a relapse occurring with a mean time of 42 days (SD 41) after delivery and a brain MRI showing a high number of Gd-enhancing lesions.
Alemtuzumab treatment in women with high disease activity and a pregnancy desire might be an option. However, it is warned that some patients could present a disease reactivation short after delivery. Thus, close monitoring is needed, especially in patients with a high disease activity during the preconception period.