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Master Thesis

Bénéfices et risques de la poursuite du natalizumab jusqu'à la fin du premier trimestre de grossesse en cas de sclérose en plaques active : étude prospective

Abstract : Objective: To compare two therapeutic strategies for women with highly active multiple sclerosis (HAMS) planning pregnancy. The first consisted in maintaining natalizumab until conception and the second until the end of first trimester. Methods: Standardized therapeutic strategy for women with HAMS planning pregnancy was initiated in 2014 in our department. Natalizumab was recommended until the end of first trimester (“secured first trimester”). When patients refused to continue natalizumab during pregnancy, they were advised to continue until conception (“secured conception”). This strategy wast proposed only in patients with anti-JC virus antibody index lower than 1.5. Predictors of disease activity during pregnancy were assessed through multivariable logistic regression models. Results: 46 pregnancies were prospectively followed (30 with “secured first trimester” and 16 with “secured conception”). Two spontaneous abortions occurred in the group “secured first trimester” and 3 in the group “secured conception”. One birth deficiency occurred in the group “secured conception”. Proportions of patients with relapse and disability progression during pregnancy were lower in the group “secured first trimester” (3.6% vs 38.5%, p<0.005 for relapse and 3.6% vs 30.8%, p<0.05 for disability). In multivariate analysis, time when natalizumab was stopped (conception vs end of first trimester) (p<0.05) and relapse rate before natalizumab (p<0.05) were associated with relapse and disability progression during pregnancy. Conclusion: Maintaining natalizumab until the end of first trimester dramatically reduces the risk of disease reactivation during pregnancy in HAMS. This strategy must be carefully discussed with patients due to lack of comprehensive data on fetal safety.
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https://dumas.ccsd.cnrs.fr/dumas-02399530
Contributor : Faculté de Médecine Amu <>
Submitted on : Monday, December 9, 2019 - 10:27:30 AM
Last modification on : Monday, July 6, 2020 - 4:47:12 PM
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  • HAL Id : dumas-02399530, version 1

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Sarah Demortiere. Bénéfices et risques de la poursuite du natalizumab jusqu'à la fin du premier trimestre de grossesse en cas de sclérose en plaques active : étude prospective. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02399530⟩

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