Abstract Details

Title Pregnancy Outcomes in Neuromyelitis Optica Spectrum Disorder: A Meta-Analysis of Pharmacotherapeutic Agents

Topic Autoimmune Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-020

Objective To analyze the evidence on outcomes of pregnancies in Neuromyelitis Optica Spectrum Disorder(NMOSD) treated with different pharmacotherapeutics.

Background Pregnancies with NMOSD present a complex scenario. Both the disease and pharmacological agents (PA) used in management have significant implications for maternal and fetal well-being.

Design/Methods A comprehensive analysis using different models, including a random-effects model, and separate analyses for specific drugs like rituximab, tocilizumab, and eculizumab was conducted. The analysis involved examining continuous variables, encompassing pregnancy age, full-term and preterm pregnancies, premature delivery, spontaneous abortion, elective termination with and without birth defects, stillbirth, and live births with birth defects. Additionally, meta-analysis was performed to assess pregnancy outcomes in NMOSD patients undergoing treatment with different PA. We excluded ravulizumab due to the limited number of studies.

Results In our meta-analysis of 31 studies investigating pregnancy outcomes in NMOSD treated with rituximab, tocilizumab, and eculizumab, we observed majority pregnancies resulted in full-term births (70.8%) with 19.5% preterm deliveries and 10.3% miscarriages. Ectopic pregnancies were rare (0.2%). Rituximab, tocilizumab, and eculizumab demonstrated varying rates of full-term births (67.6%, 63.1%, and 80.7%, respectively) and preterm deliveries (11.7%, 6.9%, and 39.4%, respectively). Birth defects were infrequent across all treatments(2.2% with rituximab, 1.9% with tocilizumab, and 0.1% with eculizumab). These findings underscore the overall safety of these medications during pregnancy in NMOSD, emphasizing the need for tailored management strategies and vigilant monitoring.

Conclusions Overall considerations from the study and existing guidelines help us conclude that although there is not enough data on the primary treatments of NMO in pregnancy and lactation, the existing literature supports informed decision-making based upon the risk-benefit ratio with careful monitoring of fetus and infants exposed to the medications.This highlights the need for more data to be gathered as NMOSD often affects females of childbearing age-group.

Authors/Disclosures
Maziar Eslami, MD (The Neurology group) PRESENTER	Dr. Eslami has nothing to disclose.
Parth A. Ladha, MBBS	Dr. Ladha has nothing to disclose.
Suban Amatya	Suban Amatya has nothing to disclose.
Yusuf Kagzi	Mr. Kagzi has nothing to disclose.
Rutvik M. Savaliya, MBBS	Dr. Savaliya has nothing to disclose.
Sema Akkus, MD (Mount Sinai West)	Dr. Akkus has nothing to disclose.
Jian Xu, MD, PhD	Dr. Xu has nothing to disclose.
Dinesh Lulla, MD (Boys Town National Research Hospital)	Dr. Lulla has nothing to disclose.
Shitiz K. Sriwastava, MBBS (UT Health Houston)	Dr. Sriwastava has nothing to disclose.

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