Elisabetta Godano1, Fabio Barra2, Alessandra Allodi1, Antonella Ferraiolo3, Alice Laroni4,5, Giovanni Novi5, Giovanni Luigi Mancardi5,6, Claudio Gustavino3, Cesare Arioni1. 1. Neonatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 2. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy. fabio.barra@icloud.com. 3. Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 4. Academic Unit of Neurology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 5. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genoa, Italy. 6. IRCCS ICS Maugeri, Pavia, Italy.
Abstract
BACKGROUND: Natalizumab is a monoclonal antibody approved for the treatment of patients with relapsing-remitting multiple sclerosis. According to the current clinical recommendations, its use during pregnancy should be carefully evaluated only in women with highly active disease who plan a pregnancy or have an unplanned pregnancy, after accurate counseling about eventual maternal disease relapse due to therapy suspension. CASE PRESENTATION: This brief case report describes a case of documented anemia that we observed in a newborn whose mother with relapsing-remitting multiple sclerosis was treated with an extended dosing protocol of natalizumab throughout pregnancy. The newborn received the infusion of erythropoietin every seven days from the fortieth day of life; subsequently, the status of anemia underwent clinical resolution. CONCLUSIONS: This case report confirmed that natalizumab can cause disorders of hematopoiesis, including anemia, thrombocytopenia, or pancytopenia, in newborns of patients treated during pregnancy. A multidisciplinary team, including experienced pediatricians and pediatric hematologists, has a critical role in managing newborns delivered by women, being treated with natalizumab for treating relapsing-remitting multiple sclerosis during pregnancy.
BACKGROUND:Natalizumab is a monoclonal antibody approved for the treatment of patients with relapsing-remitting multiple sclerosis. According to the current clinical recommendations, its use during pregnancy should be carefully evaluated only in women with highly active disease who plan a pregnancy or have an unplanned pregnancy, after accurate counseling about eventual maternal disease relapse due to therapy suspension. CASE PRESENTATION: This brief case report describes a case of documented anemia that we observed in a newborn whose mother with relapsing-remitting multiple sclerosis was treated with an extended dosing protocol of natalizumab throughout pregnancy. The newborn received the infusion of erythropoietin every seven days from the fortieth day of life; subsequently, the status of anemia underwent clinical resolution. CONCLUSIONS: This case report confirmed that natalizumab can cause disorders of hematopoiesis, including anemia, thrombocytopenia, or pancytopenia, in newborns of patients treated during pregnancy. A multidisciplinary team, including experienced pediatricians and pediatric hematologists, has a critical role in managing newborns delivered by women, being treated with natalizumab for treating relapsing-remitting multiple sclerosis during pregnancy.
Authors: Emilio Portaccio; Pietro Annovazzi; Angelo Ghezzi; Mauro Zaffaroni; Lucia Moiola; Vittorio Martinelli; Roberta Lanzillo; Vincenzo Brescia Morra; Francesca Rinaldi; Paolo Gallo; Carla Tortorella; Damiano Paolicelli; Carlo Pozzilli; Laura De Giglio; Paola Cavalla; Eleonora Cocco; Maria Giovanna Marrosu; Francesco Patti; Claudio Solaro; Paolo Bellantonio; Antonio Uccelli; Alice Laroni; Luisa Pastò; Marta Giannini; Maria Trojano; Giancarlo Comi; Maria Pia Amato Journal: Neurology Date: 2018-02-07 Impact factor: 9.910
Authors: Emilio Portaccio; Lucia Moiola; Vittorio Martinelli; Pietro Annovazzi; Angelo Ghezzi; Mauro Zaffaroni; Roberta Lanzillo; Vincenzo Brescia Morra; Francesca Rinaldi; Paolo Gallo; Carla Tortorella; Damiano Paolicelli; Carlo Pozzilli; Laura De Giglio; Paola Cavalla; Eleonora Cocco; Maria Giovanna Marrosu; Claudio Solaro; Antonio Uccelli; Alice Laroni; Luisa Pastò; Marta Giannini; Maria Trojano; Giancarlo Comi; Maria Pia Amato Journal: Neurology Date: 2018-02-07 Impact factor: 9.910