Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies

Wei Z. Yeh; Anneke Van Der Walt; Olga G. Skibina; Tomas Kalincik; Raed Alroughani; Allan G. Kermode; Marzena J. Fabis-Pedrini; William M. Carroll; Jeannette Lechner-Scott; Cavit Boz; Serkan Ozakbas; Katherine Buzzard; Mario Habek; Nevin A. John; Alexandre Prat; Marc Girard; Pierre Duquette; Seyed Mohammad Baghbanian; Suzanne Hodgkinson; Vincent Van Pesch; Guy Laureys; Barbara Willekens; Julie Prevost; Matteo Foschi; Koen De Gans; Dana Horakova; Eva Kubala Havrdova; Rana Karabudak; Francesco Patti; Pamela A. McCombe; Davide Maimone; Ayse Altintas; Radek Ampapa; Daniele Spitaleri; Oliver H.H. Gerlach; Maria Jose Sa; Stella Hughes; Riadh Gouider; Saloua Mrabet; Richard A. MacDonell; Recai Turkoglu; Elisabetta Cartechini; Abdullah Al-Asmi; Aysun Soysal; Jiwon Oh; Erwan Muros-Le Rouzic; Sabrina Guye; Noemi Pasquarelli; Helmut Butzkueven; Vilija G. Jokubaitis; MSBase Study Group; Mark Slee

doi:10.1212/NXI.0000000000200328

Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies

Wei Z. Yeh, Anneke Van Der Walt, Olga G. Skibina, Tomas Kalincik, Raed Alroughani, Allan G. Kermode, Marzena J. Fabis-Pedrini, William M. Carroll, Jeannette Lechner-Scott, Cavit Boz, Serkan Ozakbas, Katherine Buzzard, Mario Habek, Nevin A. John, Alexandre Prat, Marc Girard, Pierre Duquette, Seyed Mohammad Baghbanian, Suzanne Hodgkinson, Vincent Van PeschGuy Laureys, Barbara Willekens, Julie Prevost, Matteo Foschi, Koen De Gans, Dana Horakova, Eva Kubala Havrdova, Rana Karabudak, Francesco Patti, Pamela A. McCombe, Davide Maimone, Ayse Altintas, Radek Ampapa, Daniele Spitaleri, Oliver H.H. Gerlach, Maria Jose Sa, Stella Hughes, Riadh Gouider, Saloua Mrabet, Richard A. MacDonell, Recai Turkoglu, Elisabetta Cartechini, Abdullah Al-Asmi, Aysun Soysal, Jiwon Oh, Erwan Muros-Le Rouzic, Sabrina Guye, Noemi Pasquarelli, Helmut Butzkueven, Vilija G. Jokubaitis, MSBase Study Group, Mark Slee

College of Medicine and Public Health

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Abstract

Background and Objectives: Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods.

Methods: We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods.

Results: A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02-0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01-0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03-0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20-0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50-1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10-0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38-0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06-0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26-0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse.

Discussion: Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family.

Classification of Evidence: This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.

Original language	English
Article number	e200328
Number of pages	16
Journal	Neurology: Neuroimmunology and NeuroInflammation
Volume	11
Issue number	6
DOIs	https://doi.org/10.1212/NXI.0000000000200328
Publication status	Published - Nov 2024

Keywords

Disease
Pregnant
Postpartum
Multiple Sclerosis

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Yeh, W. Z., Van Der Walt, A., Skibina, O. G., Kalincik, T., Alroughani, R., Kermode, A. G., Fabis-Pedrini, M. J., Carroll, W. M., Lechner-Scott, J., Boz, C., Ozakbas, S., Buzzard, K., Habek, M., John, N. A., Prat, A., Girard, M., Duquette, P., Baghbanian, S. M., Hodgkinson, S., ... Slee, M. (2024). Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies. Neurology: Neuroimmunology and NeuroInflammation, 11(6), Article e200328. https://doi.org/10.1212/NXI.0000000000200328

@article{604eec9649fd472a841685e9ce173231,

title = "Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies",

abstract = "Background and Objectives: Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods.Methods: We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods.Results: A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02-0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01-0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03-0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20-0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50-1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10-0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38-0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06-0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26-0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse.Discussion: Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family.Classification of Evidence: This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.",

keywords = "Disease, Pregnant, Postpartum, Multiple Sclerosis",

author = "Yeh, {Wei Z.} and {Van Der Walt}, Anneke and Skibina, {Olga G.} and Tomas Kalincik and Raed Alroughani and Kermode, {Allan G.} and Fabis-Pedrini, {Marzena J.} and Carroll, {William M.} and Jeannette Lechner-Scott and Cavit Boz and Serkan Ozakbas and Katherine Buzzard and Mario Habek and John, {Nevin A.} and Alexandre Prat and Marc Girard and Pierre Duquette and Baghbanian, {Seyed Mohammad} and Suzanne Hodgkinson and {Van Pesch}, Vincent and Guy Laureys and Barbara Willekens and Julie Prevost and Matteo Foschi and {De Gans}, Koen and Dana Horakova and Havrdova, {Eva Kubala} and Rana Karabudak and Francesco Patti and McCombe, {Pamela A.} and Davide Maimone and Ayse Altintas and Radek Ampapa and Daniele Spitaleri and Gerlach, {Oliver H.H.} and Sa, {Maria Jose} and Stella Hughes and Riadh Gouider and Saloua Mrabet and MacDonell, {Richard A.} and Recai Turkoglu and Elisabetta Cartechini and Abdullah Al-Asmi and Aysun Soysal and Jiwon Oh and {Muros-Le Rouzic}, Erwan and Sabrina Guye and Noemi Pasquarelli and Helmut Butzkueven and Jokubaitis, {Vilija G.} and {MSBase Study Group} and Michael Barnett and Mark Slee and {Van Hijfte}, Liesbeth and Bassem Yamout and Murat Terzi and Yolanda Blanco and Pierre Grammond and Guillermo Izquierdo and Sarah Besora and Bruce Taylor and Tamara Castillo-Trivi{\~n}o and Sanchez-Menoyo, {Jose Luis} and Alessandra Lugaresi and Amato, {Maria Pia} and Todd Hardy and Danny Decoo and Yara Fragoso and Gerardo Iuliano and Orla Gray and Saladino, {Maria Laura} and Francois Grand'Maison and Sempere, {Angel Perez} and Cameron Shaw and {Van Wijmeersch}, Bart and Tunde Csepany and Claudio Solaro and Jabir Alkhaboori and Justin Garber and Dominguez, {Jose Andres} and Imre Piroska and Chris McGuigan and Marija Cauchi and Eli Skromne and Irene Trevi{\~n}o-Frenk and Deborah Mason and Sirbu, {Carmen Adella} and Masoud Etemadifar and Chiyoko Nohara and Melissa Cambron and {De Vecino}, {Maria Cecilia Aragon} and Nevin Shalaby and Deborah Field and Eduardo Aguera-Morales and Dheeraj Khurana and Riki Matsumoto and Fumitaka Shimizu and Sinnige, {L. G.F.} and Sim{\'o}n C{\'a}rdenas-Robledo",

year = "2024",

month = nov,

doi = "10.1212/NXI.0000000000200328",

language = "English",

volume = "11",

journal = "Neurology: Neuroimmunology and NeuroInflammation",

issn = "2332-7812",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "6",

}

Yeh, WZ, Van Der Walt, A, Skibina, OG, Kalincik, T, Alroughani, R, Kermode, AG, Fabis-Pedrini, MJ, Carroll, WM, Lechner-Scott, J, Boz, C, Ozakbas, S, Buzzard, K, Habek, M, John, NA, Prat, A, Girard, M, Duquette, P, Baghbanian, SM, Hodgkinson, S, Van Pesch, V, Laureys, G, Willekens, B, Prevost, J, Foschi, M, De Gans, K, Horakova, D, Havrdova, EK, Karabudak, R, Patti, F, McCombe, PA, Maimone, D, Altintas, A, Ampapa, R, Spitaleri, D, Gerlach, OHH, Sa, MJ, Hughes, S, Gouider, R, Mrabet, S, MacDonell, RA, Turkoglu, R, Cartechini, E, Al-Asmi, A, Soysal, A, Oh, J, Muros-Le Rouzic, E, Guye, S, Pasquarelli, N, Butzkueven, H, Jokubaitis, VG, MSBase Study Group & Slee, M 2024, 'Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies', Neurology: Neuroimmunology and NeuroInflammation, vol. 11, no. 6, e200328. https://doi.org/10.1212/NXI.0000000000200328

TY - JOUR

T1 - Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies

AU - Yeh, Wei Z.

AU - Van Der Walt, Anneke

AU - Skibina, Olga G.

AU - Kalincik, Tomas

AU - Alroughani, Raed

AU - Kermode, Allan G.

AU - Fabis-Pedrini, Marzena J.

AU - Carroll, William M.

AU - Lechner-Scott, Jeannette

AU - Boz, Cavit

AU - Ozakbas, Serkan

AU - Buzzard, Katherine

AU - Habek, Mario

AU - John, Nevin A.

AU - Prat, Alexandre

AU - Girard, Marc

AU - Duquette, Pierre

AU - Baghbanian, Seyed Mohammad

AU - Hodgkinson, Suzanne

AU - Van Pesch, Vincent

AU - Laureys, Guy

AU - Willekens, Barbara

AU - Prevost, Julie

AU - Foschi, Matteo

AU - De Gans, Koen

AU - Horakova, Dana

AU - Havrdova, Eva Kubala

AU - Karabudak, Rana

AU - Patti, Francesco

AU - McCombe, Pamela A.

AU - Maimone, Davide

AU - Altintas, Ayse

AU - Ampapa, Radek

AU - Spitaleri, Daniele

AU - Gerlach, Oliver H.H.

AU - Sa, Maria Jose

AU - Hughes, Stella

AU - Gouider, Riadh

AU - Mrabet, Saloua

AU - MacDonell, Richard A.

AU - Turkoglu, Recai

AU - Cartechini, Elisabetta

AU - Al-Asmi, Abdullah

AU - Soysal, Aysun

AU - Oh, Jiwon

AU - Muros-Le Rouzic, Erwan

AU - Guye, Sabrina

AU - Pasquarelli, Noemi

AU - Butzkueven, Helmut

AU - Jokubaitis, Vilija G.

AU - MSBase Study Group

AU - Barnett, Michael

AU - Slee, Mark

AU - Van Hijfte, Liesbeth

AU - Yamout, Bassem

AU - Terzi, Murat

AU - Blanco, Yolanda

AU - Grammond, Pierre

AU - Izquierdo, Guillermo

AU - Besora, Sarah

AU - Taylor, Bruce

AU - Castillo-Triviño, Tamara

AU - Sanchez-Menoyo, Jose Luis

AU - Lugaresi, Alessandra

AU - Amato, Maria Pia

AU - Hardy, Todd

AU - Decoo, Danny

AU - Fragoso, Yara

AU - Iuliano, Gerardo

AU - Gray, Orla

AU - Saladino, Maria Laura

AU - Grand'Maison, Francois

AU - Sempere, Angel Perez

AU - Shaw, Cameron

AU - Van Wijmeersch, Bart

AU - Csepany, Tunde

AU - Solaro, Claudio

AU - Alkhaboori, Jabir

AU - Garber, Justin

AU - Dominguez, Jose Andres

AU - Piroska, Imre

AU - McGuigan, Chris

AU - Cauchi, Marija

AU - Skromne, Eli

AU - Treviño-Frenk, Irene

AU - Mason, Deborah

AU - Sirbu, Carmen Adella

AU - Etemadifar, Masoud

AU - Nohara, Chiyoko

AU - Cambron, Melissa

AU - De Vecino, Maria Cecilia Aragon

AU - Shalaby, Nevin

AU - Field, Deborah

AU - Aguera-Morales, Eduardo

AU - Khurana, Dheeraj

AU - Matsumoto, Riki

AU - Shimizu, Fumitaka

AU - Sinnige, L. G.F.

AU - Cárdenas-Robledo, Simón

PY - 2024/11

Y1 - 2024/11

N2 - Background and Objectives: Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods.Methods: We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods.Results: A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02-0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01-0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03-0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20-0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50-1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10-0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38-0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06-0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26-0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse.Discussion: Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family.Classification of Evidence: This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.

AB - Background and Objectives: Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods.Methods: We performed a retrospective cohort study using data from the MSBase Registry including pregnancies conceived after December 31, 2010, from women aged 18 years and older, with relapsing-remitting MS or clinically isolated syndrome. Women were classified by preconception exposure to DMTs, including OCR, rituximab (RTX), natalizumab (NAT), stratified into active (NAT-A; continued ≥28 weeks of gestation, restarted ≤1 month postpartum) or conservative (NAT-C; continued ≤4 weeks of gestation, restarted >1 month postpartum) strategies, dimethyl fumarate (DMF) or low-efficacy DMTs (interferon-beta, glatiramer acetate). Annualized relapse rates (ARRs) were calculated for 12-month prepregnancy, pregnancy, and 6-month postpartum periods.Results: A total of 2,009 live births from 1,744 women were analyzed, including 73 live births from 69 women treated with preconception OCR. For OCR, no within-pregnancy relapse was observed and 3 women (4.1%) experienced 1 relapse in the postpartum period (ARR 0.09 [95% CI 0.02-0.27]). For NAT-A, 3 (3.7%) of 82 women relapsed during pregnancy (0.05 [0.01-0.15]) and 4 (4.9%) relapsed during postpartum (0.10 [0.03-0.26]). However, for NAT-C, 13 (15.9%) of 82 women relapsed within pregnancy (0.32 [0.20-0.51]) and 25 (30.5%) relapsed during postpartum (0.74 [0.50-1.06]). In the low-efficacy DMT group, 101 (7.6%) of 1,329 women experienced within-pregnancy relapse (0.12 [0.10-0.14]), followed by an increase in postpartum relapse activity with 234 women (17.6%) relapsing (0.43 [0.38-0.48]). This was similarly seen in the DMF group with 13 (7.9%) of 164 women experiencing within-pregnancy relapse (0.12 [0.06-0.20]) and 25 (15.2%) of 164 relapsing postpartum (0.39 [0.26-0.57]). Our RTX cohort had 0 of 24 women experiencing within-pregnancy relapse and 3 (12.5%) of 24 experiencing postpartum relapse.Discussion: Women treated with OCR or NAT-A were observed to have low relapse rates during pregnancy and postpartum. NAT-C was associated with increased risk of relapses. There was no within-pregnancy relapse in our RTX cohort, although we caution overinterpretation due to our sample size. An effective DMT strategy with a favorable safety profile for the mother and infant should be discussed and implemented well in advance of planning a family.Classification of Evidence: This study provides Class III evidence that for women with relapsing-remitting MS or clinically isolated syndrome who become pregnant, ocrelizumab, rituximab, and natalizumab (continued ≥28 weeks of gestation and restarted ≤1 month postpartum) were associated with reduced risk of relapses, compared with other therapeutic strategies.

KW - Disease

KW - Pregnant

KW - Postpartum

KW - Multiple Sclerosis

UR - http://www.scopus.com/inward/record.url?scp=85207726778&partnerID=8YFLogxK

U2 - 10.1212/NXI.0000000000200328

DO - 10.1212/NXI.0000000000200328

M3 - Article

C2 - 39442037

AN - SCOPUS:85207726778

SN - 2332-7812

VL - 11

JO - Neurology: Neuroimmunology and NeuroInflammation

JF - Neurology: Neuroimmunology and NeuroInflammation

IS - 6

M1 - e200328

ER -

Disease Activity in Pregnant and Postpartum Women with Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies

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