Glatiramer acetate during breast feeding

G
Benefits of breastfeeding | BBC Good Food
You know me, if the answer is GA, I ask what’s the question. But it is a go-to option for many neuros when you are pregnant. This study looks at the influence of GA on the breastfed offspring. You can read the conclusion.

Eighteen-month saferty analysis of offspring breastfed by mothers receiving glatiramer acetate therapy for relapsing multiple sclerosis – COBRA study.Ines Ciplea A, Kurzeja A, Thiel S, Haben S, Alexander J, Adamus E, Hellwig K.Mult Scler. 2022 Apr 1:13524585221083982. doi: 10.1177/13524585221083982. Online ahead of print

Background: Safety data on disease-modifying therapies (DMTs) for relapsing multiple sclerosis (RMS) during breastfeeding are limited.

Objective: Assess safety outcomes for offspring breastfed by mothers undergoing glatiramer acetate (GA; Copaxone®) treatment.

Methods: This non-interventional, retrospective study used German Multiple Sclerosis and Pregnancy Registry data. Participants had RMS, a live birth, and received GA or no DMT during breastfeeding.

Results: GA cohort: 58 mothers/60 offspring; matched controls: 60 mothers/60 offspring; 86.7% (GA) and 25% (control) of offspring were born to mothers who had GA at some point during pregnancy. Maternal demographics and disease activity were comparable. Annualized number of hospitalizations was similar for breastfed offspring: 0.20 (95% confidence interval: 0.09-0.31; GA) and 0.25 (0.12-0.38, controls). Proportion of offspring requiring hospitalization was comparable between cohorts (18.33% vs. 20.00%). Annualized number of antibiotic uses was similar in both cohorts (0.22, 0.10-0.33 (GA) vs. 0.17, 0.06-0.27 (controls)) The proportion of offspring requiring antibiotics was 15.00% (both cohorts). More developmental delays were identified in controls versus the GA cohort (3 (5.36%) vs. 0). Growth parameters were comparable between cohorts.

Conclusion: Maternal intake of GA during breastfeeding did not adversely affect offspring safety outcomes assessed during the first 18 months of life.

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MouseDoctor

6 comments

  • How is the obvious answer to the question of pregnancy not offering women an induction therapy and telling them to wait a year or two instead of downgrading their treatment to the shittiest drug possible? MS specialists are so full of shit.

    • I don’t know in some places they have been giving ocrelizumab and then stopping it. . However the issue is the evidence base

  • Mousedoctor, thank you for posting this info on safety of GA during breastfeeding. This type of information is scarce and very meaningful to moms with MS. Over decade ago, after aggressive MS attack while pregnant, I was advised in hospital by all medical staff/drs my dmt was not proven safe to breastfeed and not to breast feed. But the helpful, but a bit militant laleche league reps, (breast feeding proponents non profit agency) who visited me unsolicited bedside implored me to breast feed anyway because my DMT was not proven unsafe. Certainly not an ideal situation for decision making. And a perfect way to fill a new mother’s mind with fear and uncertainty. MS does that on its own, the issue of breastfeeding just heightens the anxiety. I opted to start DMT one week after birth so that I could give my newborn all the benefits of closetrum for a single week. My advice To all Breastfeeders, get the facts, discuss with medical providers and midwives, and be confident the very personal decision you make about breastfeeding is best decision for you and your baby.

  • Do you think the dosing amount/frequency of GA (20mg every day or 40mg every 3 days) is necessary as it currently is to maintain efficacy? If not, what do you think the lowest dose/frequency that would be needed to maintain efficacy?

    • If you look at AAN2022 the are posts on glateriami acetate Depot (Shall I did these out)….this is given once a month…when you have no idea what it is doing or how it is working then you shoot in the dark.Lets do it once a day once a month once evry 6 months..it is the medicinal compound (https://youtu.be/2x8D4T–0v4) after all…It is all about Intectectual property and marketing. When the 20mg daily patent eventually ran out 40mg three times weekly arrived then someone else came up with the monthly and why not the two monthy…..then 6 monthly etc. Yes I am only joking but hopefully you get the point I doubt it is based on pharmacokinetics….what is the evidence that ocrelizumab has to be given every 6 months for example

      • Yeah, I have seen the once a month 80 mg or 40 mg dosing schedule for GA depot. I can’t find anything about the half-life but even a daily continuous dose from where the depot is injected seems much lower than current GA doses. The only thing I could find on the original dosing was this excerpt below from “Multiple Sclerosis: Trial of a Synthetic Polypeptide” (https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ana.410110314)

        “The COP I first was prepared at a concentration of 5 mg per milliliter of sterile saline solution. This was to be given to each patient intramuscularly five times a week for the first three weeks, three times a week for the next three weeks, twice a week for the next three weeks, and, finally, once a week for the balance of a six-month period, at which time we originally
        planned to terminate the trial.
        During institution of the COP I treatment, many patients reported, and in fact demonstrated, early improvements in various neurological functions. As time went on and as the dosage was reduced, these early improvements disappeared. Most patients returned to their previous neurological status and continued their chronic-progressive course. During the ensuing months the dosage was gradually increased. By the end of the first eighteen-month period, those patients who were still on the COP I regimen were receiving 20 mg per day in 1 ml of saline.”

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