Is there any treatment that could keep me safe without MS attacks while breastfeeding?

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

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