The edition · Neurology
Anti-CGRP antibodies in early pregnancy were linked to more miscarriage; propranolol was not
A claims cohort of women with migraine sharpens the contraception conversation before CGRP antibodies are started. Also: ofatumumab against ocrelizumab in a national MS registry, and which dissected cervical arteries heal by six months.
The edition in brief
In 7,579 US pregnancies among women with migraine, filled anti-CGRP monoclonal antibodies in early pregnancy were associated with a higher risk of spontaneous abortion than no exposure (adjusted HR 1.42, 95% CI 1.12–1.80; bias-adjusted 1.33), while propranolol was not (aHR 1.02). The study is observational and based on claims. In a Danish registry of 1,870 people with relapsing-remitting MS, ofatumumab was associated with a slightly higher annualised relapse rate than ocrelizumab (0.05 vs 0.03; rate ratio 1.65), with no significant difference in time to relapse, disability worsening, progression independent of relapse or MRI activity; both rates were very low. In 1,095 patients with stenosing cervical artery dissection, 57.9% had fully recanalised by six months; older age, diabetes, smoking and occlusion at presentation predicted incomplete recanalisation, and antiplatelet versus anticoagulant choice made no difference.
Ofatumumab was linked to slightly more relapses than ocrelizumab, but both rates were very low
Treat ofatumumab and ocrelizumab as comparably effective for relapsing MS, and choose between them on practical grounds.
Six in ten dissected cervical arteries had fully recanalised by six months
Plan follow-up vascular imaging at about six months after cervical dissection, expecting incomplete healing more often in older, diabetic, smoking or occluded patients.
Plan migraine prevention around pregnancy before it starts
Discuss pregnancy plans and contraception every time a migraine preventive is started or reviewed.
Early pregnancy exposure to anti-CGRP antibodies was associated with higher miscarriage risk
Make contraception and pregnancy planning part of every decision to start an anti-CGRP antibody, and consider propranolol when pregnancy is planned.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free