ArticleNeurology2021
Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis.
Article in Neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
What it found
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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.
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.
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Who cites it
33 citing papers in PubMed, 77 citations in OpenAlex.
- UK consensus on pregnancy in multiple sclerosis: An update to 'Association of British Neurologists' guidance.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Review
- Bruton's Tyrosine Kinase Inhibitors in Multiple Sclerosis: Mechanistic Considerations Across Relapsing and Progressive Disease.Molecules (Basel, Switzerland) · 2026Review
- Controversies in neuroimmunology: Multiple sclerosis and other demyelinating disordersBiomedica : revista del Instituto Nacional de Salud · 2026Review
- Multiple Sclerosis in Women: Impact of Different Life Stages on Treatment Decisions.CNS drugs · 2026Review
- Disease course after pregnancy in women with progressive multiple sclerosis symptoms.Multiple sclerosis (Houndmills, Basingstoke, England) · 2025Observational
- Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability.JAMA network open · 2025Article
- Changes in circulating pro-inflammatory lymphocytes and cortical excitability with extended-interval natalizumab dosing in multiple sclerosis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Long-term safety evaluation of natalizumab during pregnancy and lactation in patients with multiple sclerosis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Four years on: Pregnancy and birth outcomes reported in the MSBase pregnancy, neonatal outcomes, and Women's Health Registry (2020-2024).Multiple sclerosis (Houndmills, Basingstoke, England) · 2025Article
- De-escalating and discontinuing disease-modifying therapies in multiple sclerosis.Brain : a journal of neurology · 2025Review
- Cost effectiveness of different treatment strategies with natalizumab for pregnant women with multiple sclerosis.Journal of neurology · 2025Article
- Pregnancy outcome in patients with multiple sclerosis: A retrospective study from single center in Benghazi, Libya.Current journal of neurology · 2025Article
- Exploring the role of sex hormones and gender diversity in multiple sclerosis.Nature reviews. Neurology · 2025Article
- Pregnancy and Infant Outcomes in Women With Multiple Sclerosis Treated With Ocrelizumab.Neurology(R) neuroimmunology & neuroinflammation · 2025Article
- Disease Activity in Pregnant and Postpartum Women With Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies.Neurology(R) neuroimmunology & neuroinflammation · 2024Article
- Patient-centered pregnancy planning in multiple sclerosis: evidence for a new era.Arquivos de neuro-psiquiatria · 2024Review
- Expert opinion on the use of contraception in people with multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2024Review
- Disease activity and neonatal outcomes after exposure to natalizumab throughout pregnancy.Journal of neurology, neurosurgery, and psychiatry · 2024Observational
- Practical Considerations for Managing Pregnancy in Patients With Multiple Sclerosis: Dispelling the Myths.Neurology. Clinical practice · 2024Review
- Use of multiple sclerosis disease-modifying therapies during pregnancy in France: Nationwide study between 2010 and 2021.Multiple sclerosis (Houndmills, Basingstoke, England) · 2024Article
Corrections and comments
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Authors and funding
47 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort.
methodsUsing data from the MSBase Registry, we included pregnancies conceived after 31 Dec 2010 from women with relapsing-remitting MS or clinically isolated syndrome. Predictors of intrapartum relapse, and postpartum relapse and disability progression were determined by clustered logistic regression or Cox regression analyses.
resultsWe included 1998 pregnancies from 1619 women with MS. Preconception annualized relapse rate (ARR) was 0.29 (95% CI 0.27-0.32), fell to 0.19 (0.14-0.24) in third trimester, and increased to 0.59 (0.51-0.67) in early postpartum. Among women who used fingolimod or natalizumab, ARR before pregnancy was 0.37 (0.28-0.49) and 0.29 (0.22-0.37), respectively, and increased during pregnancy. Intrapartum ARR decreased with preconception dimethyl fumarate use. ARR spiked after delivery across all DMT groups. Natalizumab continuation into pregnancy reduced the odds of relapse during pregnancy (OR 0.76 per month [0.60-0.95], p=0.017). DMT re-initiation with natalizumab protected against postpartum relapse (HR 0.11 [0.04-0.32], p<0.0001). Breastfeeding women were less likely to relapse (HR 0.61 [0.41-0.91], p=0.016). 5.6% of pregnancies were followed by confirmed disability progression, predicted by higher relapse activity in pregnancy and postpartum.
conclusionIntrapartum and postpartum relapse probabilities increased among women with MS after natalizumab or fingolimod cessation. In women considered to be at high relapse risk, use of natalizumab before pregnancy and continued up to 34 weeks gestation, with early re-initiation after delivery is an effective option to minimize relapse risks. Strategies of DMT use have to be balanced against potential fetal/neonatal complications.
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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.