MS Compass: Guiding Clinical Care

Welcome to the MS Compass: Guiding Clinical Care podcast. A clinician-focused podcast led by Lindsay Ross, MD, of Cleveland Clinic, exploring the research, care decisions, and evolving conversations shaping MS treatment for women. In this initial episode of MS Compass: Guiding Clinical Care, host Lindsay Ross, MD, is joined by Edith Graham, MD, assistant professor of neurology at Northwestern University Feinberg School of Medicine, for an in-depth discussion on managing multiple sclerosis during breastfeeding. The conversation examines how postpartum care decisions are evolving as more safety, pharmacokinetic, and infant outcome data become available, particularly around the use of disease-modifying therapies during lactation. Drs Ross and Graham discuss the growing comfort with anti-CD20 monoclonal antibodies, how relapse risk and breastfeeding physiology factor into treatment timing, and the practical considerations clinicians weigh when counseling patients during this critical phase of MS care.Episode Breakdown:  0:50 – How frequently clinicians continue disease-modifying therapy during breastfeeding 2:15 – Shifting from interferons to monoclonal antibodies in postpartum MS care 3:30 – Lactation physiology and what it means for monoclonal antibody transfer into breast milk 5:50 – Safety data for anti-CD20 therapies including ocrelizumab, ofatumumab, and rituximab 8:15 – Practical differences across anti-CD20 agents and how they influence treatment selection 13:50 – Adjusting infusion premedications to reduce infant exposure during breastfeeding 16:50 – The unique challenges of natalizumab use during the postpartum period 20:10 – Weaning physiology, premature infants, and remaining gaps in breastfeeding safety data 24:30 – Balancing breastfeeding-related relapse protection against postpartum relapse risk 26:55 – Why many clinicians are moving toward a “why not treat” mindset during breastfeeding 28:40 – Recent relapses drive postpartum DMT restart decisions 29:30 – Postpartum prophylactic steroids discouraged; COP-MS shows none 31:15 – Anti-CD20 postpartum outcomes still lack robust data 33:40 – LactMed-guided symptom meds: gabapentin, baclofen, Botox, PT Thanks for listening to the NeurologyLive® Inside MS: A Clinician's Compass podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.