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I was diagnosed with MS in 2012. Have been on Copaxone since 9 weeks pp. My son is now 5 months and 16 days, was born full-term and no known health problems. After my last MRI on August 26, 10 hyperintensive lesions were found on my brain. My neurologist feels Tysabri is the way we need to go to control the lesions. I have been informed by him that I should discontinue breastfeeding. I do NOT want to. Do I have any options? Can I pump and discard a few days after treatment?
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Dana:
We finished a preliminary study on Tysabri last year. In this study, we demonstrated rising levels of natalizumab in breastmilk in one patient with an estimated RID of 2–5%. However, this study only followed the infants for 50 days and natalizumab requires up to 28 weeks to achieve steady state.Therefore, the authors suggest that further research is needed to evaluate levels at steady state and risks to the
breastfed infant. Although no adverse effects were reported in the infant, it is categorized as probably compatible but with limited data.
In essence, natalizumab levels tended to rise over the 50 days in our study, but the manufacturer states that steady state levels don't occur until 28 weeks or 196 days. . So I am somewhat concerned that the levels of Tysabri might continue to rise above our last level.
While we know it transfers to some degree in milk, it's not clear whether any of it is actually absorbed by the infant's gut. It probably isn't to any significant degree. At this point I know that a lot of women have chosen to breastfeed and I've yet to hear of any complication in their breastfed infant.
Lastly, you cannot avoid this drugs peak, it has a long half life and it would be impossible to avoid its peak.
Reference:
T. E. Baker, S. D. Cooper, L. Kessler, and T. W. Hale, “Transfer of natalizumab into breast milk in a mother with multiple sclerosis,” Journal of Human Lactation, vol. 31, no. 2, pp. 233–
236, 2015.
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Are there any other MS drugs that are safer for breastfeeding besides Copaxone?Comment
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Not many. Beta Interferon, and High dose IV methylprednisolone are probably safe. Below are some references you can get from a medical library.
Tom Hale
Management of Multiple Sclerosis in the Breastfeeding Mother. ([url]http://www.ncbi.nlm.nih.gov/pubmed/26966579[/url])
Almas S, Vance J, Baker T, Hale T.
Mult Scler Int. 2016;2016:6527458. doi: 10.1155/2016/6527458. Epub 2016 Feb 4. Review.
PMID: 26966579
Transfer of methylprednisolone into breast milk in a mother with multiple sclerosis. ([url]http://www.ncbi.nlm.nih.gov/pubmed/25691380[/url])
Cooper SD, Felkins K, Baker TE, Hale TW.
J Hum Lact. 2015 May;31(2):237-9. doi: 10.1177/0890334415570970. Epub 2015 Feb 17.
PMID: 25691380
Similar articles ([url]http://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=25691380[/url])
Select item 255867122.
Transfer of natalizumab into breast milk in a mother with multiple sclerosis. ([url]http://www.ncbi.nlm.nih.gov/pubmed/25586712[/url])
Baker TE, Cooper SD, Kessler L, Hale TW.
J Hum Lact. 2015 May;31(2):233-6. doi: 10.1177/0890334414566237. Epub 2015 Jan 13.
PMID: 25586712
Similar articles ([url]http://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=25586712[/url])
Select item 219886023.
Transfer of interferon β-1a into human breastmilk. ([url]http://www.ncbi.nlm.nih.gov/pubmed/21988602[/url])
Hale TW, Siddiqui AA, Baker TE.
Breastfeed Med. 2012 Apr;7(2):123-5. doi: 10.1089/bfm.2011.0044. Epub 2011 Oct 11.
PMID: 21988602
Similar articles ([url]http://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=21988602[/url])
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