Evidence map›Paper›PMID 32461351›Full record

SynthesisNeurology(R) neuroimmunology & neuroinflammation2020

Transfer of monoclonal antibodies into breastmilk in neurologic and non-neurologic diseases.

Sara C LaHue, Annika Anderson, Kristen M Krysko, Alice Rutatangwa, Morna J Dorsey, Thomas Hale, Uma Mahadevan, Elizabeth E Rogers, Melissa G Rosenstein, Riley Bove

Registry-linked trialOpen access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurology(R) neuroimmunology & neuroinflammation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06940323 (Pregnancy Registry, Infants, Serum/Milk Analysis), which is not on this map. Cited by 24 papers.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed
6.3field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06940323 recruitingnot on this map

Pregnancy Registry, Infants, Serum/Milk Analysis (PRISMA): Pregnancy Registry for Women With Chronic Conditions

TypeobservationalSponsorUniversity of California, San FranciscoRan2017 to 2035Enrolled250ConditionsMultiple Sclerosis, Clinically Isolated Syndrome, NMOSD, Myasthenia Gravis
3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 51 citations in OpenAlex.

  1. Article
  2. Assessing the Safety of Medications During Lactation: Lactation safety.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2026
    Article
  3. Review
  4. Article
  5. Article
  6. Topical review: Lactation and use of DMTs in women with MS.Multiple sclerosis (Houndmills, Basingstoke, England) · 2024
    Review
  7. Review
  8. Article
  9. Review
  10. Article
  11. Review
  12. Article
  13. Review
  14. Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy.Degenerative neurological and neuromuscular disease · 2022
    Review
  15. Review
  16. Article
  17. Article
  18. Treatment of Women with Multiple Sclerosis Planning Pregnancy.Current treatment options in neurology · 2021
    Review
  19. Review
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Sara C LaHueFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Annika AndersonFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.ORCID 0000-0002-7288-6344
Kristen M KryskoFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.ORCID 0000-0003-0090-597X
Alice RutatangwaFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Morna J DorseyFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Thomas HaleFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Uma MahadevanFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Elizabeth E RogersFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Melissa G RosensteinFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA.
Riley BoveFrom the Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), School of Medicine, University of California San Francisco; Department of Neurology (S.C.L., A.A., K.M.K., A.R., R.B.), Weill Institute for Neurosciences, University of California San Francisco; Department of Pediatrics (M.J.D.), Division of Allergy, Immunology and Blood and Marrow Transplant, University of California San Francisco, CA; Department of Pediatrics (T.H.), Texas Tech University School of Medicine, Amarillo, TX; Department of Gastroenterology (U.M.), University of California San Francisco; Department of Pediatrics (E.E.R.), University of California San Francisco; and Department of Obstetrics (M.G.R.), Gynecology, and Reproductive Sciences, University of California San Francisco, CA. riley.bove@ucsf.edu.
Texas Tech University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo review currently available data on the transfer of monoclonal antibodies (mAbs) in the breastmilk of women receiving treatment for neurologic and non-neurologic diseases.

methodsWe systematically searched the medical literature for studies referring to 19 selected mAb therapies frequently used in neurologic conditions and "breastmilk," "breast milk," "breastfeeding," or "lactation." From an initial list of 288 unique references, 29 distinct full-text studies met the eligibility criteria. One additional study was added after the literature search based on expert knowledge of an additional article. These 30 studies were reviewed. These assessed the presence of our selected mAbs in human breastmilk in samples collected from a total of 155 individual women.

resultsDrug concentrations were typically low in breastmilk and tended to peak within 48 hours, although maximum levels could occur up to 14 days from infusion. Most studies did not evaluate the breastmilk to maternal serum drug concentration ratio, but in those evaluating this, the highest ratio was 1:20 for infliximab. Relative infant dose, a metric comparing the infant with maternal drug dose (<10% is generally considered safe), was evaluated for certolizumab (<1%), rituximab (<1%), and natalizumab (maximum of 5.3%; cumulative effects of monthly dosing are anticipated). Importantly, a total of 368 infants were followed for ≥6 months after exposure to breastmilk of mothers treated with mAbs; none experienced reported developmental delay or serious infections.

conclusionsThe current data are reassuring for low mAb drug transfer to breastmilk, but further studies are needed, including of longer-term effects on infant immunity and childhood development.

Indexed as

LactationPostpartum PeriodAdultAntibodies, MonoclonalAutoimmune DiseasesFemaleHumansImmunologic FactorsMilk, HumanAntibodies, MonoclonalImmunologic Factors

Identifiers

PMID32461351
PMCPMC7286664
OpenAlexW3030767837

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.