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Ocrevus while breastfeeding twins

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  • Ocrevus while breastfeeding twins

    I would very much appreciate your opinion on my current situation. I am currently breastfeeding my 1 year old twins and hope to continue for as long as possible. I have a diagnosis of relapse remitting multiple sclerosis and started back on disease modifying treatment in May of this year- I have been on Tysabri with my neurologist’s approval and continued to breastfeed. However, I have had some new symptoms and changes on a recent MRI so my neurologist wants me to consider changing to Ocrevus. He has stated that there is not as much long term evidence for the safety of the child to recommend continuing to breastfeed (as there is for Tysabri) but I am aware that some women do continue while on Ocrevus. I would be very grateful if you could provide me with any relevant research and/or your professional opinion if it would be safe to continue to breastfeed? (I am of course aware that not drug can be considered/declared totally safe) My twins will likely be at least 15 or 16 months by the time I would be starting on Ocrevus. Thank you so much

  • #2

    Ocrelizumab is a recombinant humanized monoclonal antibody directed against CD20-expressing B-cells and is indicated for the treatment of Multiple Sclerosis. It is a glycosylated immunoglobulin G1 (IgG1) and binds to the CD20 cell surface antigen present in B cells involved in multiple sclerosis. While no levels in milk have been published, it is likely they are low, and that present, is probably not orally bioavailable. Other such monoclonal antibodies are virtually unabsorbed orally in humans. There are no published data on the transfer of ocrelizumab into human milk, although it was excreted in the milk of ocrelizumab-treated monkeys. This product could potentially reduce B-cell populations in the gut, and could lead to higher rates of gut infections in infants.

    I think the risk is low, but we have no data as of yet on this product. At 1 year you'd have to make a judgement whether the risk is worth the benefit. Part of this assessment is determining just how much milk you actually produce and deliver to the infant. IF it is low, say < 200 cc/day, then the risk to your infant is probably low. IF more, then the risk is higher.

    Caution is recommended with this antibody.

    Tom Hale Ph.d.


    • #3
      Thank you very much for taking the time to reply, I really appreciate it