Alemtuzumab and Breastfeeding

Summary of use during lactation

No information is available on the clinical use of alemtuzumab during breastfeeding. Because alemtuzumab is a large protein molecule with a molecular weight of 145,454 Da, the amount in milk is likely to be very low.[1] It is also likely to be partially destroyed in the infant's gastrointestinal tract and absorption by the infant is probably minimal.[2] Until more data become available, alemtuzumab should be used with caution or avoided in nursing mothers during treatment for multiple sclerosis, especially while nursing a newborn or preterm infant.[3-7] Waiting for at least 2 weeks postpartum to resume therapy may minimize transfer to the infant.[7] The manufacturer recommends that women not breastfeed during treatment and for at least 3 months following the last dose.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Multiple Sclerosis) Glatiramer, Immune Globulin, Interferon Beta

References

1. Stratigakis A, Paty D, Zou P, et al. A regression approach for assessing large molecular drug concentration in breast milk. Reprod Breed 2023;3:199-207. doi:10.1016/j.repbre.2023.10.003
2. Anderson PO. Monoclonal antibodies during breastfeeding. Breastfeed Med 2021;16:591-3.33956488 PubMed
3. Bove R, Alwan S, Friedman JM, et al. Management of multiple sclerosis during pregnancy and the reproductive years: A systematic review. Obstet Gynecol 2014;124:1157-68.25415167 PubMed
4. Cree BA. Update on reproductive safety of current and emerging disease-modifying therapies for multiple sclerosis. Mult Scler 2013;19:835-43.23319073 PubMed
5. Almas S, Vance J, Baker T, Hale T. Management of multiple sclerosis in the breastfeeding mother. Mult Scler Int 2016;2016:6527458.26966579 PubMed
6. Iyer P, Dobson R. Multiple sclerosis in pregnancy: A commentary on disease modification and symptomatic drug therapies. Neurol Ther 2023;12:1-10.
7. Krysko KM, Dobson R, Alroughani R, et al. Family planning considerations in people with multiple sclerosis. Lancet Neurol 2023;22:350-66.36931808 PubMed