在有生育潜力的多发性硬化症和视神经脊髓炎谱系障碍女性中使用B细胞耗竭疗法。
Use of B-Cell-Depleting Therapy in Women of Childbearing Potential With Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder.
作者信息
Galati Alexandra, McElrath Thomas, Bove Riley
机构信息
Division of Neuroimmunology and Glial Biology (A.G., R.B.), Department of Neurology, University of California, San Francisco, UCSF Weill Institute for the Neurosciences, San Francisco, CA; and Brigham & Women's Hospital, Harvard Medical School, Boston, MA.
出版信息
Neurol Clin Pract. 2022 Apr;12(2):154-163. doi: 10.1212/CPJ.0000000000001147.
PURPOSE OF REVIEW
There is considerable heterogeneity in the use of B-cell depletion in women of childbearing age, likely driven at least in part by the discrepancy between the product labels and what is known about the physiology of IgG1, including breastmilk and placental transfer.
RECENT FINDINGS
We provide practical considerations on the use of this medication class in women of childbearing potential. We discuss prepregnancy planning including vaccinations, safety of B-cell depletion during pregnancy, and postpartum considerations including breastfeeding.
SUMMARY
B-cell-depleting monoclonal antibodies have shown to be effective for prepregnancy and postpartum prevention of inflammatory activity in MS and neuromyelitis optica spectrum disorder. B-cell-depleting therapies are large IgG1 monoclonal antibodies, which have minimal transfer across the placenta and into breastmilk. Consideration of risks and benefits of these therapies should be considered in counseling women planning pregnancy and postpartum.
综述目的
育龄期女性使用B细胞耗竭疗法存在相当大的异质性，这可能至少部分是由产品标签与已知的IgG1生理学之间的差异所驱动的，包括母乳和胎盘转运。
最新发现
我们提供了关于在有生育潜力的女性中使用这类药物的实际考虑因素。我们讨论了孕前规划，包括疫苗接种、孕期B细胞耗竭的安全性以及产后考虑因素，包括母乳喂养。
总结
B细胞耗竭单克隆抗体已被证明对孕前和产后预防多发性硬化症和视神经脊髓炎谱系障碍中的炎症活动有效。B细胞耗竭疗法是大型IgG1单克隆抗体，它们极少穿过胎盘并进入母乳。在为计划怀孕和产后的女性提供咨询时，应考虑这些疗法的风险和益处。
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