Pharmacotherapeutic considerations in women with multiple sclerosis

Abstract

Introduction: Multiple sclerosis (MS) is a chronically progressive disease of the central nervous system. The relapsing form of the disease predominantly affects women with onset between the ages 20 to 40 years. Therefore, timing, choice, and treatment options should take pregnancy planning into consideration to accommodate both the needs and safety of the mother and health of the fetus. Areas covered: In this review, the authors discuss and summarize the recent evidence of different pharmacotherapeutic possibilities in the treatment of women with MS. Expert opinion: There is evidence that disease modifying therapy reduces the risk of relapses and diminishes disability progression in people with relapsing MS. The disease is often diagnosed in the childbearing years, and thus pregnancy planning can possibly be a part of the pharmacotherapeutic considerations. The management of women planning pregnancy requires a balancing of risks. The clinician must consider the risks related to treatment discontinuation versus the risk of exposing the developing fetus to drugs that are potential fetotoxic. Randomized controlled trials of medication safety-if used during pregnancy, are prohibited for ethical reasons; hence, the evidence is continuously gathered from observational data, post-authorization studies and pregnancy registries.

Pregnancy outcomes following maternal or paternal exposure to teriflunomide in the Danish MS population

“…The disease typically manifests in the early adult life between the age of 20 to 40, presenting a higher frequency in females than males with a sex-ratio of approximately 2-3:1 2 . The combination of female predilection and disease onset in the childbearing age calls for careful pharmacotherapeutic considerations in relation to potential pregnancies 3 . Teriflunomide (TFL) is a once-daily oral, immunomodulatory agent approved for treatment of MS by the Food and Drug Administration in 2012 4 and European Medicine Agency in 2013 5 .…”