Anti-CD20 therapy and pregnancy planning in multiple sclerosis

Pregnancy rates are rapidly increasing among women of reproductive age diagnosed with multiple sclerosis (MS). Over the past decades, several studies have proven that MS does not affect the course of pregnancy, and pregnancy does not negatively affect the long-term course of the disease. The results of numerous studies have shown that the frequency of exacerbations in MS patients decreases during pregnancy, but increases after childbirth. According to the summary of product characteristics (SmPC) of disease modifying drugs (DMD) most of them are contraindicated during pregnancy. To prevent possible neonatal risks, it is necessary to use contraception before pregnancy planning for a certain period of time after their last use. Medical data of MS pregnancy registries of patients receiving DMD before, during pregnancy and postpartum provide important information for the formation of further therapeutic approaches. The most valuable are the data from prospective studies with clearly selected points for analysis, including both pregnancy outcomes and newborns health. In the group of anti-CD20 drugs, ocrelizumab has the largest database of use during pregnancy. In February 2025, an expert Advisory Council (AC) was held to review and analyze data on the use of anti-CD20 therapy in family planning. According to AC expert’s opinion the use of ocrelizumab 4.5 months before the planned pregnancy does not have an increased risk of adverse neonatal outcomes and allows effectively to control disease activity during pregnancy and in the postpartum period.