AntiCD20 monoclonal antibody therapy effectively reduces disease activity in multiple sclerosis (MS) before conception up until after birth, found a new study published in the Annals of Clinical and Translational Neurology. The therapy also has minimal transfer into breast milk and is safe and well-tolerated by both the mother and the baby. 

The authors concluded that these findings may support the use of monoclonal antibodies to manage pregnant and breastfeeding women with neurological conditions, including MS, neuromyelitis optica spectrum disorder (NMOSD), and myasthenia gravis.

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Pregnant women with autoimmune diseases may wish to resume the use of disease-modifying therapies following the delivery of their baby. 

The aim of the present study was to determine whether or not ocrelizumab and rituximab, disease-modifying therapies containing antiCD20 antibodies, are transferred into breastmilk and to assess their effect on the mother and the baby.

The team analyzed 57 women with MS or NMOSD treated with ocrelizumab or rituximab after 59 pregnancies. All women and their babies were followed up to a year after delivery.

The researchers collected the women’s breastmilk before the infusion of the disease-modifying therapies and serially up to 90  days after infusion to check for the concentration of antiCD20 antibodies.

They found that the median average concentration of monoclonal antibodies in the breastmilk was 0.08  μg/mL. The concentration peaked 1 to 7 days after infusion in the majority of women and was almost undetectable after 90  days. The median average relative infant dose was less than 1%. 

A total of 43 women continued to breastfeed after infusion. At 8 to 12  months, there were no differences between the babies who were breastfed and those who were not in terms of growth and development. Only 2 women experienced a clinical relapse after postpartum infusion, 1 of whom had NMOSD.


Anderson A, Rowles W, Poole S, et al. Anti-CD20 monoclonal antibody therapy in postpartum women with neurological conditions. Ann Clin Transl Neurol. Published online September 7, 2023. doi:10.1002/acn3.51893