Influence of Pregnancy in Multiple Sclerosis and Impact of Disease-Modifying Therapies

Simone, Isabella Laura; Tortorella, Carla; Ghirelli, Alma

doi:10.3389/fneur.2021.697974

Cited by 24 publications

(21 citation statements)

References 144 publications

(190 reference statements)

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“…The introduction of DMT significantly changed pregnancy planning in women with MS. One of the strongest risk factors for postpartum relapse is untreated MS two years before conception. IFNβ and GA are allowed during pregnancy, while IFNβ beta is allowed during breastfeeding as well ( 17 ).…”

Section: Recommendations For Initiation Of Treatment Of Pwms With Pla...mentioning

confidence: 99%

Treatment of relapsing multiple sclerosis – recommendations of the Croatian Neurological Society

et al. 2022

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Untreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present (≥9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging [MRI] or ≥3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse ≥3), high-efficacy DMT should be initiated. If pwMS experience ≥1 relapse or ≥3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS.

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Section: Recommendations For Initiation Of Treatment Of Pwms With Pla...mentioning

confidence: 99%

Treatment of relapsing multiple sclerosis – recommendations of the Croatian Neurological Society

et al. 2022

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“…Alemtuzumab is another monoclonal antibody with a molecular weight of 150 kDa, a half-life of 4-5 days, and complete elimination in 30 days that interacts with the CD52 surface receptor on cells [61]. Premature labor, hypertension, low birth weight, and neurocognitive impairment are some fetal concerns associated with using alemtuzumab during pregnancy [62,63].…”

Section: Alemtuzumabmentioning

confidence: 99%

“…In contrast to monoclonal antibodies, alemtuzumab does not cross the placental during the first trimester. Nevertheless, it recommends using effective contraception for women under alemtuzumab therapy for at least four months after completion of treatment [61]. Oh et al indicated that among 264 pregnancies exposed to alemtuzumab, 67% were live births without anomalies, 22% spontaneous abortions, 11% elective abortions, and one stillbirth [61].…”

Section: Alemtuzumabmentioning

confidence: 99%

“…Nevertheless, it recommends using effective contraception for women under alemtuzumab therapy for at least four months after completion of treatment [61]. Oh et al indicated that among 264 pregnancies exposed to alemtuzumab, 67% were live births without anomalies, 22% spontaneous abortions, 11% elective abortions, and one stillbirth [61]. Also, alemtuzumab is excreted in breast milk, like the majority of monoclonal antibodies; hence, breastfeeding is not advised [61].…”

Section: Alemtuzumabmentioning

confidence: 99%

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Multiple sclerosis impact on pregnancy: An update on management issues

Badali

Ghorbaninia

Mohammadian³

et al. 2022

GMJ

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Women with multiple sclerosis (MS) of reproductive age are becoming pregnant at an alarmingly high rate. Disease control is required during the preconception, prenatal, and postpartum periods to reduce the likelihood of relapses of MS while minimizing hazards to the mother and fetus. It has long been understood that the disease activity of MS noticeably decreases in the third trimester of pregnancy, then noticeably increases in the first three months after delivery before returning to its pre-pregnancy baseline. Relapse during pregnancy and high rates of relapse before becoming pregnant have both been linked to an increased risk of postpartum attacks. In patients with relapse MS, recent results continue to support the notion that pregnancy does not affect long-term disease progression (and may even have the opposite effect); the situation is less clear for patients with progressive MS. It is comforting to know that none of the MS disease-modifying medications have been shown to cause teratogenic consequences. This review discusses the effects of pregnancy on disease activity and how to handle relapses when pregnant and breastfeeding.

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“…As a result, studies have shown a risk of hematological disorders such as anemia and thrombocytopenia in the newborns of mothers exposed to NAT during their third trimester [6]. However, these hematological alterations were back to normal within four months after birth in most patients, without much intervention [7].…”

Section: Introductionmentioning

confidence: 99%

Adverse Obstetric Outcomes in Pregnant Women Using Natalizumab for the Treatment of Multiple Sclerosis: A Systematic Review

Ramesh¹,

Opara²,

Khan³

et al. 2022

Cureus

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Multiple sclerosis is a common disease in women of childbearing age, characterized by demyelination of the central nervous system. Among the different treatment options available, disease-modifying therapies (DMTs) are the most efficacious, and natalizumab (NAT) is an injectable DMT best for relapsing-remitting multiple sclerosis. However, it comes under pregnancy category C drug classification. This systematic review aims to analyze the adverse outcomes of using NAT during pregnancy.PubMed/Medline, PubMed Central (PMC), ScienceDirect, and Google Scholar were the databases used to search for articles. Appropriate keywords and Medical Subject Headings (MeSH) strategy were used to identify relevant articles. Articles were then screened using inclusion/exclusion criteria followed by the title and abstract screening. The Joanna Briggs Institute (JBI) quality appraisal tools were used for quality check, and nine articles were finalized for review.NAT suspension during pregnancy is shown to have a high risk of disease relapse. Despite the risk of mild hematological abnormalities in the newborn and the risk of spontaneous abortions at the same rate as that of the general population, NAT use can be considered safe in pregnancy. These adverse outcomes can be minimized by strict monitoring of patients. Studies of better quality with larger sample sizes are needed for further investigation.

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Influence of Pregnancy in Multiple Sclerosis and Impact of Disease-Modifying Therapies

Cited by 24 publications

References 144 publications

Treatment of relapsing multiple sclerosis – recommendations of the Croatian Neurological Society

Treatment of relapsing multiple sclerosis – recommendations of the Croatian Neurological Society

Multiple sclerosis impact on pregnancy: An update on management issues

Adverse Obstetric Outcomes in Pregnant Women Using Natalizumab for the Treatment of Multiple Sclerosis: A Systematic Review

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