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Interrupting DMT due to pregnancy increases NfL levels

MS Virtual 2020
Interrupting disease-modifying treatment (DMT) leads to higher serum neurofilament light chain (sNfL) levels during pregnancy and the DMT-free postpartum period [1]. This elevation was independent of relapses, suggesting increased subclinical disease activity during this time span. sNfL may qualify as a sensitive and minimally-invasive measure of MS disease activity during pregnancy.

A total of 72 pregnancies in 63 relapsing MS patients were evaluated. Median age was 31.4 years, median disease duration 7.1 years, median EDSS 1.5 at last visit before birth, and median follow-up 6 years. Of 433 included samples, 167 were taken before pregnancy, 92 during pregnancy/DMT-free postpartum, and 174 after pregnancy. Most patients (n=39) were treated with fingolimod or natalizumab as last medication before birth; 4 patients did not use a DMT before, during, and after pregnancy. In 14 of 72 pregnancies, DMT exposure during pregnancy was >6 months; in 39 pregnancies, exposure was limited to the first 2 trimesters; in 15 pregnancies, treatment was discontinued before getting pregnant.

Relapses were more likely in the first trimester and the first 3 months postpartum. sNfL levels increased towards the last trimester and in the first 3 months postpartum, not only in women who relapsed. Mean sNfL levels were 22% higher during pregnancy (β=1.22; P<0.001). During the postpartum, 29 relapses occurred. Relapses were associated with 98% higher sNfL (β=1.98; P<0.001). Mean sNfL was 13% higher during the postpartum period (β=1.13; P=0.009). However, this difference lost significance after including DMT exposure into the model (β=1.07; P=0.178). Patients sampled during DMT had on average 12% lower sNfL levels compared with patients without (β=0.88; P=0.019). The authors concluded that strategies allowing to continue DMT during pregnancy may be warranted.

  1. Yaldizli Ö, et al. Interrupting disease modifying treatment for pregnancy in multiple sclerosis – effect on disease activity and serum neurofilament light chain. MSVirtual 2020, Abstract LB01.06.


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