Tom 18, Nr 3 (2022)
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Opublikowany online: 2022-09-29
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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Przeciwciała monoklonalne w leczeniu stwardnienia rozsianego w aspekcie ciąży. Ryzyko dla dziecka, korzyści dla matki

Iwona Rościszewska-Żukowska1, Halina Bartosik-Psujek1
Pol. Przegl. Neurol 2022;18(3):151-162.

Streszczenie

Stwardnienie rozsiane to zapalna demielinizacyjna choroba ośrod kowego układu ner wowego dotycząca młodych dorosłych. Częściej występuje u młodych kobiet (3:1) w wieku prokreacyjnym, dlatego ważnym jej aspektem jest ciąża. W ostatnim dziesięcioleciu w populacji kobiet ze stwardnieniem rozsianym obserwuje się stały wzrost liczby ciąż, na co wpływają nie tylko dane o potwierdzonym ochronnym wpływie ciąży na aktywność rzutową, ale również zwiększająca się dostępność skutecznych leków modyfikujących przebieg choroby. Planowanie ciąży z oceną wpływu leków na płodność, ciążę, na sam płód i laktację jest ważne. Istotna jest również ocena ryzyka zwiększenia aktywności choroby w związku z planowaną ciążą. Dużym wyzwaniem pozostaje planowanie ciąży u kobiet z wysoce aktywną chorobą. Takie pacjentki mogą wymagać kontynuacji terapii w ciąży lub pr zygotowania do ciąży popr zez terapię deplecyjną. P rzeciwciała monoklonalne mogą być wówczas bardzo dobrą opcją terapeutyczną. W pracy pr zedstawiono aktualne dane na temat bezpieczeństwa w aspekcie ciąży wszystkich stosowanych w leczeniu stwardnienia rozsianego przeciwciał monoklonalnych. Omówiono ich farmakokinetykę i farmakodynamikę, wpływ na płodność, ryzyko dla ciąży (poronienia, wady wrodzone) i dla noworodków. Przedstawiono dane na temat skuteczności przeciwciał monoklonalnych w hamowaniu rzutów, oceniając ryzyko zwiększonej aktywności rzutowej w związku z zakończeniem terapii w okresie ciąży. Informacje te mogą pomóc dobrać lek na podstawie należycie oszacowanej przewagi korzyści dla matki nad ryzykiem dla dziecka.

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