Is it correct for a woman with multiple sclerosis to forgo medication because she may become pregnant?

Fragoso, Yára Dadalti

doi:10.1590/0004-282x20130134

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…All the published data come from observational reports and may not be considered very robust [ 84 ]. On the other hand, the overly simplistic solution of withdrawing all treatments from women who intend to conceive (or are already pregnant) does not take into consideration the potential severity of MS [ 85 ]. Severe rebounding of MS activity may occur when fingolimod or natalizumab is withdrawn during pregnancy (or at the time of pregnancy planning) [ 86 – 91 ].…”

Section: The Effect Of Ms Therapy On Childbearingmentioning

confidence: 99%

Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children

et al. 2018

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Multiple sclerosis (MS) management presently aims to reach a state of no (or minimal) evidence of disease activity. The development and commercialization of new drugs has led to a renewed interest in family planning, since patients with MS may face a future with reduced (or no) disease-related neurological disability. The advice of neurologists is often sought by patients who want to have children and need to know more about disease control at conception and during pregnancy and the puerperium. When MS is well controlled, the simple withdrawal of drugs for patients who intend to conceive is not an option. On the other hand, not all treatments presently recommended for MS are considered safe during conception, pregnancy and/or breastfeeding. The objective of the present study was to summarize the practical and evidence-based recommendations for family planning when our patients (women and men) have MS.Funding TEVA Pharmaceutical Brazil.

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Section: The Effect Of Ms Therapy On Childbearingmentioning

confidence: 99%

Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children

et al. 2018

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“…Analysis of a global database of 425 pregnancies exposed to IFN b-1a followed prospectively determined that there was no increased risk of either spontaneous abortions or congenital anomalies [Sandberg-Wollheim et al 2011]. Many practitioners recommend discontinuing IFN prior to attempts at conception, though in certain cases, there are those who argue it may be acceptable to continue IFNs up to conception, or even throughout pregnancy [Coyle et al 2004;Fragoso, 2013;Ghezzi et al 2013].…”

Section: Safetymentioning

confidence: 99%

“…Many practitioners recommend discontinuing IFN prior to attempts at conception, though in certain cases, there are those who argue it may be acceptable to continue IFNs up to conception, or even throughout pregnancy [Coyle et al . 2004; Fragoso, 2013; Ghezzi et al . 2013].…”

Section: Ifn β (Ifn β-1a: Rebif Avonex Plegridy; Ifn β-1b: Betaseromentioning

confidence: 99%

Optimizing the initial choice and timing of therapy in relapsing-remitting multiple sclerosis

Farber

Sand

2015

Ther Adv Neurol Disord

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With 12 available US Food and Drug Administration approved medications for the treatment of relapsing multiple sclerosis (MS), choosing an initial therapy is no longer a straightforward task. Each disease-modifying therapy (DMT) has a distinct risk-benefit profile and each patient is an individual. Therefore, the development of a simple algorithm to apply in selecting initial therapy is not feasible. Instead, the prescribing physician must consider many factors related to the treatments themselves, such as efficacy, safety, and tolerability, while also taking into account a particular patient's disease characteristics, personal preferences, comorbid illnesses and reproductive plans. The efficacy of each drug may be assessed through clinical trial data, although these data are limited by scarcity of direct comparisons among the different agents and lack of availability of biomarkers to predict an individual patient's response. Differences in safety profiles help to distinguish the various DMTs and influence selection of agent; both the known safety concerns, which can be addressed with risk mitigation and monitoring strategies, and the potential for yet undiscovered safety issues must be assessed, and an individual patient's comfort level with the risks and ability to comply with monitoring must be determined. Potential issues related to tolerability, which largely relate to matters of patient personal preference and lifestyle, should also be factored into the decision-making process. With regard to the timing of therapy initiation, it must be acknowledged that long-term benefits of early DMT have not yet been definitively demonstrated. Nonetheless, starting DMT early in the MS disease course has been shown to have a beneficial effect on relapse prevention, and appears to curtail the atrophy and neurodegenerative changes that are now known to begin at disease onset. Although under certain circumstances there are acceptable reasons for deferring treatment, it is generally recommended that DMT is initiated early in the disease course.

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Adverse events and monitoring requirements associated with monoclonal antibody therapy in patients with multiple sclerosis

Fragoso

2019

Drugs Ther Perspect

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Is it correct for a woman with multiple sclerosis to forgo medication because she may become pregnant?

Cited by 4 publications

References 10 publications

Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children

Practical Evidence-Based Recommendations for Patients with Multiple Sclerosis Who Want to Have Children

Optimizing the initial choice and timing of therapy in relapsing-remitting multiple sclerosis

Adverse events and monitoring requirements associated with monoclonal antibody therapy in patients with multiple sclerosis

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