Neuromyelitis optica spectrum disorders and pregnancy: therapeutic considerations

Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearin...

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Vydané v:Nature reviews. Neurology Ročník 16; číslo 3; s. 154 - 170
Hlavní autori: Mao-Draayer, Yang, Thiel, Sandra, Mills, Elizabeth A, Chitnis, Tanuja, Fabian, Michelle, Katz Sand, Ilana, Leite, M Isabel, Jarius, Sven, Hellwig, Kerstin
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England Nature Publishing Group 01.03.2020
Predmet:
Abnormalities, Drug-Induced
Abortion, Spontaneous - chemically induced
Adult
Autoimmune diseases
Female
Humans
Immunologic Factors - adverse effects
Neuromyelitis Optica - drug therapy
Neuromyelitis Optica - immunology
Obstetric Labor Complications - chemically induced
Pre-Eclampsia - chemically induced
Pregnancy
ISSN:1759-4758, 1759-4766, 1759-4766
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Abstract Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.
AbstractList Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation. In this Review, the authors discuss the relationship between pregnancy outcomes and NMOSD disease activity, and outline potential treatment approaches.
Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.
Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.
Author Jarius, Sven
Mao-Draayer, Yang
Leite, M Isabel
Thiel, Sandra
Chitnis, Tanuja
Mills, Elizabeth A
Fabian, Michelle
Katz Sand, Ilana
Hellwig, Kerstin
Author_xml – sequence: 1
  givenname: Yang
  surname: Mao-Draayer
  fullname: Mao-Draayer, Yang
  organization: Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
– sequence: 2
  givenname: Sandra
  surname: Thiel
  fullname: Thiel, Sandra
  organization: Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
– sequence: 3
  givenname: Elizabeth A
  surname: Mills
  fullname: Mills, Elizabeth A
  organization: Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
– sequence: 4
  givenname: Tanuja
  orcidid: 0000-0002-9897-4422
  surname: Chitnis
  fullname: Chitnis, Tanuja
  organization: Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
– sequence: 5
  givenname: Michelle
  surname: Fabian
  fullname: Fabian, Michelle
  organization: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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  givenname: Ilana
  surname: Katz Sand
  fullname: Katz Sand, Ilana
  organization: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
– sequence: 7
  givenname: M Isabel
  surname: Leite
  fullname: Leite, M Isabel
  organization: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
– sequence: 8
  givenname: Sven
  surname: Jarius
  fullname: Jarius, Sven
  organization: Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
– sequence: 9
  givenname: Kerstin
  orcidid: 0000-0003-4467-9011
  surname: Hellwig
  fullname: Hellwig, Kerstin
  email: k.hellwig@klinikum-bochum.de
  organization: Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany. k.hellwig@klinikum-bochum.de
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Snippet Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often...
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SubjectTerms Abnormalities, Drug-Induced
Abortion, Spontaneous - chemically induced
Adult
Autoimmune diseases
Female
Humans
Immunologic Factors - adverse effects
Neuromyelitis Optica - drug therapy
Neuromyelitis Optica - immunology
Obstetric Labor Complications - chemically induced
Pre-Eclampsia - chemically induced
Pregnancy
Title Neuromyelitis optica spectrum disorders and pregnancy: therapeutic considerations
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