Understanding Ocrelizumab’s Safe and Efficacious Profile in Preconceiving Women With MS: Kristen Krysko, MD

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"I'm no longer recommending a washout; they can start trying to conceive again immediately following an ocrelizumab infusion, and that allows their MS to continue to be treated while they are attempting to conceive."

Pregnancy planning and management in women with multiple sclerosis (MS) remains a complex clinical challenge, particularly in the context of high-efficacy disease-modifying therapies and concerns about fetal safety, miscarriage, and long-term infant outcomes. Emerging pharmacovigilance and registry data have begun to clarify the risks associated with exposure to anti-CD20 therapies, including ocrelizumab (Ocrevus; Genentech), in the preconception and periconception periods, as well as inadvertent exposure during early pregnancy. These data are increasingly informing counseling around treatment continuation versus washout and shaping contemporary approaches to family planning in MS.

At the 2026 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 27-29, Charlotte, North Carolina, Kristen Krysko, MD, neurologist at the BARLO MS Centre at St. Michael's Hospital, presented findings from an analysis that evaluated pregnancy outcomes among women with MS who had received ocrelizumab, including more than 800 pregnancies with exposure in 3 months of conception.¹ Drawing from the Roche Global Safety Database, the findings suggested no increased risk of major adverse pregnancy outcomes, miscarriage, or congenital malformations, offering reassuring evidence to guide treatment decisions around conception.

In a follow-up interview with NeurologyLive^®, Krysko discussed how these findings can be applied in clinical practice for women with MS who are considering pregnancy, actively attempting to conceive, or who have had inadvertent exposure to ocrelizumab during early gestation. She addressed evolving counseling practices around the need or lack thereof for treatment washout, residual uncertainties related to infant and maternal infection risk, and the importance of long-term follow-up data in exposed offspring.

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REFERENCES
1. Krysko KM, Dobson R, Vukusic S. A Decade of Pregnancy Outcomes in Women with Multiple Sclerosis Receiving Ocrelizumab: Analysis of Over 5000 Pregnancies. Presented at: 2026 CMSC Annual Meeting; May 27-29; Charlotte, North Carolina. Abstract DMT05.