Objectives: To assess the impact of timing of natalizumab cessation/redosing on long-term maternal and infant outcomes in 72 out of the original 74 pregnancies of the Italian Pregnancy Dataset in multiple sclerosis (MS). Methods: Maternal outcomes in patients who received natalizumab until conception and restarted the drug within 1 month after delivery ("treatment approach," (TA)) and patients who stopped natalizumab before conception and/or restarted the drug later than 1 month after delivery ("conservative approach," (CA)) were compared through multivariable Cox regression analyses. Pediatric outcomes were assessed through a semi-structured questionnaire. Results: After a mean follow-up of 6.1 years, CA (hazard ratio (HR) = 4.1, 95% CI 1.6-10.6, p = 0.003) was the only predictor of relapse occurrence. Worsening on the Expanded Disability Status Scale (EDSS) was associated with higher annualized relapse-rate during the follow-up (HR = 3.3, 95% CI 1.4-7.9 p = 0.007). We found no major development abnormalities in children. Discussion: Our data confirm that TA reduces the risk of disease activity; we did not observe an increase in major development abnormalities in the child.
Natalizumab treatment and pregnancy in multiple sclerosis: A reappraisal of maternal and infant outcomes after 6 years / Portaccio, Emilio; Pastò, Luisa; Razzolini, Lorenzo; Moiola, Lucia; Martinelli, Vittorio; Annovazzi, Pietro; Ghezzi, Angelo; Zaffaroni, Mauro; Lanzillo, Roberta; Brescia Morra, Vincenzo; Rinaldi, Francesca; Gallo, Paolo; Gasperini, Claudio; Paolicelli, Damiano; Simone, Marta; Pozzilli, Carlo; De Giglio, Laura; Cavalla, Paola; Cocco, Eleonora; Marrosu, Maria Giovanna; Patti, Francesco; Solaro, Claudio; Comi, Giancarlo; Filippi, Massimo; Trojano, Maria; Amato, Maria Pia. - In: MULTIPLE SCLEROSIS. - ISSN 1352-4585. - 28:13(2022), pp. 2137-2141. [10.1177/13524585221079598]