Disease-modifying drugs for multiple sclerosis in pregnancy

Lu, Ellen; Wang, Bing Wei; Guimond, Colleen; Synnes, Anne; Sadovnick, Dessa; Tremlett, Helen

doi:10.1212/wnl.0b013e3182698c64

Cited by 147 publications

(121 citation statements)

References 31 publications

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“…It is thought to activate regulatory T-cells that recognize the myelin basic protein antigen. Similar to IFN, GA does not seem to affect the rate of conception nor the rate of spontaneous abortion when compared to women without MS, and no major concerns have been reported when GA has been used in pregnancy [22]. Women who have used GA during breast-feeding report no adverse effects, although it is still recommended to abstain from GA during lactation [24].…”

Section: Effect Of Dmt On Pregnancymentioning

confidence: 98%

“…In clinical trials comparing IFN therapy to placebo, IFN did not affect the rate of conception nor the rate of spontaneous abortion [20,21]. However, IFN exposure was associated with a significantly lower birth weight and preterm birth [22]. The degree and significance of IFN transfer through breast milk has not been established, but it is suggested that IFN be avoided during breast-feeding [23].…”

Section: Effect Of Dmt On Pregnancymentioning

confidence: 99%

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The Effects of Multiple Sclerosis and Disease Modifying Therapy on Pregnancy

Johal

2017

UOJM

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Multiple sclerosis (MS) is a common inflammatory disorder of the central nervous system (CNS) in which the myelin sheath is targeted and subsequently degraded. In MS, disease modifying therapies (DMT) aim to decrease the relapse rates and decrease the number of lesions in the brain and spinal cord. Several different types of DMTs exist with distinct properties and mechanisms of action. This is beneficial because the clinical course of MS varies from individual to individual, and so treatment must be tailored to each individual's unique disease.Since the proportion of women with MS is larger than that of men, the concept of managing MS with DMT while also taking into account pregnancy and fertility issues constitutes an important discussion. DMT may be useful for treating MS, but it can have negative effects on a woman if she is pregnant, trying Keywords: Multiple Sclerosis; Pregnancy; Disease Modifying Therapy; Teratogenicity; Breastfeeding Multiple sclerosis (MS) is the most common inflammatory condition of the central nervous system. Disease modifying therapy (DMT) aims to reduce relapse rates and decrease the quantity of lesions in the brain and spinal cord. Since MS is more prevalent in women than men, it is important to be aware of the interplay between MS and pregnancy. As MS can engender sexual dysfunction, primarily in the form of decreased desire and fatigue, it thereby affects conception. Hormonal differences between women with MS compared to women without MS include an increase in follicle-stimulating hormone and luteinizing hormone, and a decrease in testosterone. While fluctuations in estrogen result in a reduction in MS relapse rates during pregnancy, a subsequent increase in the post-partum period is observed. The mechanism of action and side effects of DMTs are described in this paper, including interferon, glatiramer acetate, and some newer medications. Although there are no recommended guidelines on the use of DMTs during pregnancy, it is generally agreed upon to cease their use prior to conception if possible, and the decision to continue a DMT should take into account the benefits to the mother and the risks to the fetus. Comprehending the mechanisms of action and teratogenicity indices of DMTs is crucial in understanding their effects on MS during pregnancy, which is an important aspect of providing health care to women with this condition.Tarneer Johal, BSc 1 1 Faculty of Medicine, University of British Columbia ABSTRACT RÉSUMÉ La sclérose en plaques (SP) est l'affection inflammatoire du système nerveux central la plus commune. Le traitement modificateur de la maladie (DMT, de l'anglais) vise à réduire les taux de poussées et à diminuer le nombre de lésions au cerveau et à la moelle épinière. Comme la SP est plus prévalente chez les femmes que chez les hommes, il est important de reconnaître l'interaction entre la SP et la grossesse. Puisque la SP peut engendrer une dysfonction sexuelle, principalement en raison d'une diminution du désir sexuel et de la fatigue, elle affecte la conception...

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Section: Effect Of Dmt On Pregnancymentioning

confidence: 98%

Section: Effect Of Dmt On Pregnancymentioning

confidence: 99%

The Effects of Multiple Sclerosis and Disease Modifying Therapy on Pregnancy

Johal

2017

UOJM

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“…Even though there is a lack of well-controlled data on pregnancyrelated risks for all DMTs, some data suggest that GA may have the best safety profile among the first-line DMTs with regard to this common patient need. Copaxone received the most favorable Food and Drug Administration (FDA) pregnancy label (category B), but data are considered insufficient and further research seems necessary [13].…”

Section: Gamentioning

confidence: 99%

“…If the patient is concerned about rare and maybe even not-yet-known adverse effects, the injectables might be a good choice because of the years of experience with these drugs. Also, women with child-bearing potential that plan to become pregnant, or at least keep open the possibility of becoming pregnant, may also opt for the injectables (in particular GA [13]). Women that are planning to become pregnant should probably not use teriflunomide.…”

Section: Initiation Of Therapymentioning

confidence: 99%

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

2016

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Treatment options in relapsing-remitting multiple sclerosis have increased considerably in recent years; currently, a dozen different preparations of diseasemodifying therapies are available and some more are expected to be marketed soon. For the treating neurologist this broad therapeutic repertoire not only greatly improves individualized management of the disease, but also makes choices more complex and difficult. A number of factors must be considered, including disease activity and severity, safety profile, and patient preference. We here discuss the currently existing options and suggest treatment algorithms for managing relapsing-remitting multiple sclerosis.

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“…The primary population typically affected by MS comprises young women who nowa days receive assurances that pregnancy will not have a de leterious effect on the disease 1 . However, the withdrawa l of all MS medications is recommended to women who choose to become pregnant or experience an unplanned pregnancy 2 . In fact, it is recommended that a woman who does not make use of effective methods of contraception should not be treated for MS.…”

mentioning

confidence: 99%