Managing Postpartum MS: Safety Data, Relapse Risk, and Real-World Practice
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Welcome to the Inside MS: A Clinician's Compass podcast. A clinician-focused podcast led by Lindsay Ross, MD, of Cleveland Clinic, exploring the research, care decisions, and evolving conversations shaping MS treatment for women.
In this initial episode of Inside MS: A Clinician's Compass, host Lindsay Ross, MD, is joined by Edith Graham, MD, assistant professor of neurology at Northwestern University Feinberg School of Medicine, for an in-depth discussion on managing multiple sclerosis during breastfeeding. The conversation examines how postpartum care decisions are evolving as more safety, pharmacokinetic, and infant outcome data become available, particularly around the use of disease-modifying therapies during lactation. Drs Ross and Graham discuss the growing comfort with anti-CD20 monoclonal antibodies, how relapse risk and breastfeeding physiology factor into treatment timing, and the practical considerations clinicians weigh when counseling patients during this critical phase of MS care.
Episode Breakdown:
- 0:50 – How frequently clinicians continue disease-modifying therapy during breastfeeding
- 2:15 – Shifting from interferons to monoclonal antibodies in postpartum MS care
- 3:30 – Lactation physiology and what it means for monoclonal antibody transfer into breast milk
- 5:50 – Safety data for anti-CD20 therapies including ocrelizumab, ofatumumab, and rituximab
- 8:15 – Practical differences across anti-CD20 agents and how they influence treatment selection
- 13:50 – Adjusting infusion premedications to reduce infant exposure during breastfeeding
- 16:50 – The unique challenges of natalizumab use during the postpartum period
- 20:10 – Weaning physiology, premature infants, and remaining gaps in breastfeeding safety data
- 24:30 – Balancing breastfeeding-related relapse protection against postpartum relapse risk
- 26:55 – Why many clinicians are moving toward a “why not treat” mindset during breastfeeding
- 28:40 – Recent relapses drive postpartum DMT restart decisions
- 29:30 – Postpartum prophylactic steroids discouraged; COP-MS shows none
- 31:15 – Anti-CD20 postpartum outcomes still lack robust data
- 33:40 – LactMed-guided symptom meds: gabapentin, baclofen, Botox, PT
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