title: Natalizumab for the prevention of post-partum relapses in women with multiple sclerosis.
abstract: OBJECTIVE
  Our aim was to evaluate the impact of early redosing of natalizumab after delivery on the risk of post-partum relapses in six women with very active multiple sclerosis (MS).
  
  
  METHODS
  We undertook a retrospective analysis of data collected prospectively in the Lyon MS Cohort.
  
  
  RESULTS
  The annualized relapse rate (ARR) in the year before natalizumab treatment was 4.2 ±0.4, which decreased to 0.4 ±0.6 during the treatment period. The mean time between natalizumab withdrawal and onset of pregnancy was 9 months; one pregnancy was exposed to one infusion. The ARR between natalizumab withdrawal and onset of pregnancy was 1.8 ±0.7. Six relapses occurred before onset of pregnancy and seven during pregnancy. Natalizumab was restarted 7.8 days after delivery (between day 2 and 8 for five patients and on day 23 for one). Only one patient, who had restarted natalizumab 2 days after delivery, had a relapse 2 weeks later. The others five patients were relapse free after a mean of 14.2 ±9.1 months of follow-up.
  
  
  CONCLUSIONS
  Despite a high risk of post-partum relapses, early redosing of natalizumab led to a complete disappearance of disease activity in all but one patient. These data suggest that natalizumab could be a good candidate for preventing early post-partum relapses.
authors.affiliation: Service de Neurologie A and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Equipe Neuro-oncologie et Neuro-inflammation, Lyon, France/Université de Lyon, Lyon, France/Université Lyon 1, Lyon, France sandra.vukusic@chu-lyon.fr.
authors.forename: Sandra
authors.initials: S
authors.lastname: Vukusic
authors.affiliation: Service de Neurologie A and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Durand-Dubief
authors.affiliation: Service de Neurologie A and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Benoit
authors.affiliation: Service de Neurologie A and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Equipe Neuro-oncologie et Neuro-inflammation, Lyon, France/Université de Lyon, Lyon, France/Université Lyon 1, Lyon, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Marignier
authors.affiliation: Service de Neurologie A and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Equipe Neuro-oncologie et Neuro-inflammation, Lyon, France/Université de Lyon, Lyon, France/Université Lyon 1, Lyon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Frangoulis
authors.affiliation: Service de Neurologie A and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Equipe Neuro-oncologie et Neuro-inflammation, Lyon, France/Université de Lyon, Lyon, France/Université Lyon 1, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Confavreux
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use*; D049590:Postpartum Period / Q000187:drug effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab
keywords: Multiple sclerosis; natalizumab; post-partum; pregnancy; relapses