Treatment of NMOSD in Female Patients of Reproductive Age During Pregnancy or Family Planning
Managing neuromyelitis optica spectrum disorder (NMOSD) in female patients of reproductive age requires specific attention when the patient is pregnant or planning to become pregnant. Treatment selection in this setting is shaped by the safety profile of agents during pregnancy and the need for early counseling.
Clinical Scenario
Female patients of reproductive age with AQP4-IgG-positive NMOSD must be counseled early regarding family planning options and the risks and benefits of both pregnancy and ongoing immunotherapy. This protocol applies to those who are currently pregnant or planning pregnancy in the near future.
When attacks occur during pregnancy, specific acute interventions are available, including apheresis therapy.
Treatment Approach (Partial Overview)
Long-term immunotherapy is continued through pregnancy using agents considered acceptable in this context — including certain monoclonal antibodies. The specific choice of agent depends on the patient's current pregnancy status. Medications identified as teratogenic must be avoided and replaced with safer alternatives before conception.
The complete protocol — including which agents to use or avoid, how to switch therapy, and the full clinical decision pathway — is available via the link below.
References
- Female patients of reproductive age with AQP4-IgG-positive NMOSD must be counseled early on regarding family planning options and the risks and benefits of both pregnancy and immunotherapies during pregnancy.
- Treatment options for attacks during pregnancy include high-dose glucocorticoids and apheresis therapy (preferably with IA).
- Monoclonal antibodies (eculizumab/ravulizumab, rituximab, tocilizumab)* or azathioprine should be continued during pregnancy.
- Given the limited data on the use of monoclonal antibodies during pregnancy, rituximab should be preferred for female patients who are planning to become pregnant in the near future.
- Female patients with a stable disease under azathioprine who become pregnant should continue treatment.
- Teratogenic drugs such as mycophenolate mofetil or methotrexate should be avoided in patients of childbearing age and must be replaced with safer options prior to pregnancy.
DOI: 10.1007/s00415-024-12288-2
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