Here is My Question:
MS treatment during Breastfeeding

Hi! I got pregnant 3 months after my last Ocrevus infusion. I am 13 weeks now and feeling ok without receiving any MS treatment. However, I am aware of the increased risk of relapse after delivery and I'd love to breastfeed if at all possible. Please, do you know of any treatment that could keep me safe without MS attacks during the breastfeeding time? Thanks so much!

Answer:
Ocrelizumab is a large protein and very little should be detected in breast milk, even shortly after an infusion, as long as you do not receive the ocrelizumab infusion during the first week of breast feeding. The small amount that is found in breast milk will be destroyed by gastric secretions and will not be absorbed by the infant in a biologically active form. This information is based on studies of other large monoclonal protein therapies. To my knowledge no one has measured the amount of Ocrelizumab in breast milk as of this writing. There are anecdotal reports of breastfeeding mothers receiving either Ocrevus or one of the other anti-CD20 monoclonal antibodies with no evidence of harm to the infant. 

We recommend that patients with MS and their MS specialist assess the risk of relapse post-partum and make a determination of the best time to resume treatment. We hold off on the resumption of treatment until after the mother stops breast feeding, if the mother's disease activity risk factors were low before starting the therapy. If we do hold off on the resumption of disease modifying therapy after the baby is born, we will often pause breastfeeding between 6 and 12 weeks postpartum to repeat imaging studies to reassess the risk of a postpartum relapse before either resuming breastfeeding or ceasing breastfeeding to restart MS treatment.

Good luck to you

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

Here is My Question:
Can the MS treatment (medicine) AUBAGIO cause shingles?

Answer:
Shingles is not a listed risk of treatment with Teriflunomide (Aubagio) for Multiple sclerosis. However, many of the MS DMTs, including Aubagio, can potentially suppress immune responses and increase your risk of unusual infections or reactivation of dormant viruses like varicella, the cause of shingles. This is more common in older patients (> 50), those with prior immunosuppression and those with a lowering of absolute lymphocyte counts on therapy.

We encourage our patients to obtain a Shingrix vaccine if they are over the age of 50 and receiving a potentially immunosuppressive therapy. This vaccine is very effective at lowering the risk of shingles.

​Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

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-The HealthCare Journey Team

Here is My Question:
Do you have to wash out Betaseron before switching to Ocrevus?
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Answer:
There is no scientific or medical reason to, "wash-out" any interferon beta therapeutic agent (this includes Betaseron, Extavia, Avonex, Rebif or Plegridy) before starting another disease modifying therapy (DMT), unless the interferon is being discontinued because of a lab abnormality or side effect. If the switch is occurring for either of these reasons, it is prudent to wait until the lab abnormality or side effect improves before initiating the new DMT. The necessity of waiting to start a new DMT is usually based on the clinical circumstances and judgement of the treating physician.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego

Here is My Question:
There's a report out that Ocrevus canceled out chicken pox antibodies in someone with RRMS. How does that affect someone with PPMS who would like to get the shingles vaccine Shingrix?

Answer:
B-cell biologics can lower antibody production levels and can hamper the humoral immune response to vaccination. When b-cells are transiently absent (depleted) after an infusion, vaccines are less effective and should be planned in a timeframe that takes this into account. The exact number of b-cells needed to mount a robust antibody response is of research interest right now.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

Here is My Question:
I am a male age 39, and I'm having a variety of fun symptoms (as my doctor calls them), and I'm now awaiting an EMG exam.

I've had a MRI without contrast fluid on brain, upper spine and lower spine without any findings. Was unusally fine for my age group.

I've had sensory changes, an odd feeling on half my tongue, and unilateral facial pain/numbness. l've also had a headache with ear pain and pain above my eye socket. Usually it is located on the right, but can suddenly change to the left with no warning, but with an identical pattern. But always one sided.

No weakness but left and right side of my body feels different. I also experience muscle twitching with no pattern, for example left bicep twitches for 3-4 seconds, then on my right calf, then on my left little finger.

I also experience slight sensation reduction around the body, and no vibration sensation in my right leg (but can sense tapping, rolling, position changes, and touching just not vibrations.

What are the chances this could be MS? I'm starting to get real anxious of a potential MS diagnosis. No MS in my family but migraines and idiopathic peripheral neuropathy on my mother's side and diabetes on my father's side..

If this ends up with a MS diagnosis, how is the prognosis for people diagnosed nowadays?

Answer:
Sorry to hear of the variety of "fun" symptoms.

If it is correct that your MRI of the brain and spinal cord is normal, then it is highly unlikely that you have MS.

From what you shared, it does make sense to study your peripheral nervous system (that is the EMG/nerve conduction study) since your symptoms could arise from this rather than the central nervous system (which was imaged on the MRI).

Although I doubt you have MS based on the information provided, to answer your last question, the treatment of MS has come a long way over the past 2 decades that I've been following MS patients in the clinic.  While therapeutics haven't reached the "cure" level yet, we do have highly effective therapies now that in some patients can achieve a state called "no evidence of disease activity" which essentially means a permanent remission status.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente