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AAN 2024: Are MS drugs taken while breastfeeding safe for children?

March 21, 2024

A new study from Germany suggests that monoclonal antibody (mAb) exposure during breastfeeding had no negative effect on the development or health of breastfed infants during the first 36 months of life. More detailed results from this study will be presented at the upcoming American Academy of Neurology annual meeting in Denver.

This finding is important, say researchers, as the risk of MS relapses increases after giving birth so that some mothers may need or want to restart these therapies.

Study highlights

• For the study, researchers used the German MS and Pregnancy Registry to identify 183 infants born to mothers taking monoclonal antibodies while breastfeeding.
• Of this group, 180 had mothers with MS and three had mothers with neuromyelitis optica spectrum disease.
• Primary outcomes (hospitalizations, systemic antibiotic use, developmental delay, weight at follow-up visits) were compared between breastfed mAb-exposed (exposed group) and unexposed (control group) infants.
• The first exposures to the medications through breastfeeding ranged from the day a child was born to the ninth month of life.
• Infants were breastfed for an average of five-and-a-half months while their mothers took these medications.
• 183 mAb breastfed exposed cases (median follow-up 1 year, range 0.5-3) with a diagnosis of MS (n=180) or neuromyelitis optica spectrum disease (n=3) were identified, with no significant differences in demographic characteristics compared to the control group (n=183).
• Natalizumab (n=125/68.31%) was most commonly used, followed by ocrelizumab (n=34/18.58%), rituximab (n=11/6.01%), and ofatumumab (n=10/5.46%); therapy was switched from natalizumab to ocrelizumab in 2 cases (1.09%), from rituximab to ocrelizumab in 1 case (0.55%) while breastfeeding.
• Adjusted regression analyses showed no association of annual hospitalization (rate ratio 1.23; 95% confidence interval [CI] 0.70, 2.16; p 0.473), annual systemic antibiotic use (rate ratio 1.55; 95%CI 0.93, 2.57; p 0.093), developmental delay (odds ratio [OR] 1.16; 95% CI 0.52 ,2.60; p 0.716), or infants' weight at follow-up visits with mAb exposed breastfeeding.
• A limitation of the study was that only about a third of the infants were followed for the full three years.

Sources:

Witt L, et al. Child development after exposure to monoclonal antibodies during breastfeeding. Presented at: 2024 American Academy of Neurology 76th Annual Meeting; April 13-18, 2024; Denver, CO. https://aanfiles.blob.core.windows.net/aanfiles/862a1d63-d480-4512-8bd8-4e814316126e/2024%20AAN%20Annual%20Meeting%20Abstract%20-%20Breastfeeding%20and%20MS

(2024, March 4). American Academy of Neurology. Good News—MS drugs Taken While Breastfeeding May Not Affect Child Development. https://www.aan.com/PressRoom/Home/PressRelease/5153