Family planning in women treated with ocrelizumab. How do the latest data influence clinical practice? Review article

Abstract

Family planning in women with multiple sclerosis represents a significant clinical challenge, requiring both effective disease control and minimization of risks to the fetus and newborn. In recent years, the approach to the use of disease-modifying therapies has evolved substantially with the introduction of early high-efficacy treatment strategies including, among others, anti-CD20 monoclonal antibodies, alongside the emergence of new data from observational studies and real-world clinical practice. In this context, therapies that induce a long-lasting therapeutic effect, such as ocrelizumab, have gained particular importance, as they allow for more flexible treatment management, including in the setting of pregnancy planning. Increasing evidence suggests that treatment prior to conception may contribute to disease stability during pregnancy and reduce the risk of postpartum relapses. At the same time, there is a gradual shift away from prolonged treatment-free intervals before planned pregnancy toward a more individualized approach that takes into account disease activity and patient preferences. Despite the growing body of evidence supporting a favorable safety profile of ocrelizumab in the context of family planning, significant discrepancies between recommendations and clinical practice persist. Further research is needed to optimize treatment strategies and to better define the long-term safety of therapy in this specific patient population. This paper discusses key aspects of pregnancy planning in women with multiple sclerosis in the context of ocrelizumab therapy, including assessment of disease activity, optimal timing of the last dose, the role of the so-called „therapeutic window,” and management across different clinical scenarios. Current data on pregnancy outcomes, the postpartum period, breastfeeding, and the impact of treatment on the neonatal immune system are also reviewed.