Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: An Australian and New Zealand perspective Part 3 Treatment practicalities and recommendations

Broadley, Simon; Barnett, Michael; Boggild, Mike; Brew, Bruce J.; Butzkueven, Helmut; Heard, Robert; Hodgkinson, S.; Kermode, Allan G.; Lechner‐Scott, Jeannette; Macdonell, Richard; Marriott, Mark; Mason, Deborah; Parratt, John; Reddel, Stephen W.; Shaw, Cameron; Slee, Mark; Spies, Judith M.; Taylor, Bruce; Carroll, William M.; Kilpatrick, Trevor J.; King, John; McCombe, Pamela A.; Pollard, John D.; Willoughby, Ernest

doi:10.1016/j.jocn.2014.01.017

Cited by 21 publications

(18 citation statements)

References 95 publications

(85 reference statements)

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“…Disease-modifying therapies aim to lessen the number, severity and duration of relapses, maintain remission, and slow progression. These therapies are usually immunomodulatory and/or immunosuppressive treatments such as, interferon beta, copaxone, fingolimod, natalizumab and alemtuzumab [5][6][7]. Symptomatic therapies that relieve the distressing and/or disabling symptoms of multiple sclerosis include: anticonvulsants for neuropathic pain, anticholinergic drugs for bladder dysfunction and dysphagia, and botulinum toxin injections for spasticity [1].…”

Section: Introductionmentioning

confidence: 99%

The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews

Nielsen

Germanos

Weier

et al. 2018

Curr Neurol Neurosci Rep

131

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We identified 11 eligible systematic reviews providing data from 32 studies, including 10 moderate to high quality RCTs. Five reviews concluded that there was sufficient evidence that cannabinoids may be effective for symptoms of pain and/or spasticity in MS. Few reviews reported conclusions for other symptoms. Recent high quality reviews find cannabinoids may have modest effects in MS for pain or spasticity. Future research should include studies with non-cannabinoid comparators; this is an important gap in the evidence.

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Section: Introductionmentioning

confidence: 99%

The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews

Nielsen

Germanos

Weier

et al. 2018

Curr Neurol Neurosci Rep

131

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“…The lack of long term and comprehensive studies has resulted in the universal recommendation that multiple sclerosis treatments are not safe for use in pregnancy and that, ideally, treatment should be discontinued before conception . Elimination recommendations for the currently available therapies are based on their known pharmacokinetic profiles (Box 3).…”

Section: Management Of Patients Who Are Planning a Pregnancymentioning

confidence: 99%

“…Elimination recommendations for the currently available therapies are based on their known pharmacokinetic profiles (Box 3). Contraception should be continued during the washout period to ensure that a pregnancy does not occur …”

Section: Management Of Patients Who Are Planning a Pregnancymentioning

confidence: 99%

“…No treatment for multiple sclerosis is currently listed as being safe for use while breastfeeding (Box 4). The passage of molecules in breast milk is thought to be governed by the size of the molecules, with larger molecules (≥ 800 Da) not being able to penetrate mammary epithelial cell junctions.…”

Section: Management Of Patients Who Are Planning a Pregnancymentioning

confidence: 99%

“…Several agents are either not excreted in breast milk or are thought to be digested by the neonatal gastrointestinal tract, which becomes impermeable to large molecules after the first few days of life (Box 4). Breastfeeding while exposed to monoclonal antibodies (molecular weight ~ 140 000 kDa) used in inflammatory bowel disease and rheumatoid arthritis has been studied more thoroughly than in multiple sclerosis. It appears that monoclonal antibodies concentrations in breast milk rise to a peak concentration within a few hours .…”

Section: Management Of Patients Who Are Planning a Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

Family planning, antenatal and post partum care in multiple sclerosis: a review and update

Walt

Nguyen

Jokubaitis

2019

Medical Journal of Australia

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Summary Multiple sclerosis is more prevalent in women of childbearing age than in any other group. As a result, the impact of multiple sclerosis and its treatment on fertility, planned and unplanned pregnancies, post partum care and breastfeeding presents unique challenges that need to be addressed in everyday clinical practice. Given the increasing number of disease‐modifying agents now available in Australia for the treatment of multiple sclerosis, there is a growing need for clinicians to provide their patients with appropriate counselling on family planning. Providing better evidence regarding the relative risks and benefits of continuing therapy before, during and after pregnancy is an important research priority. International pregnancy registries are essential in developing better evidence‐based practice guidelines, and neurologists should be encouraged to contribute to these when possible. The management of women with multiple sclerosis, especially when they are taking disease‐modifying agents, requires careful assessment of fertility and disease characteristics as well as a multidisciplinary approach to ensure positive outcomes in both mothers and their children.

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Treatment with disease modifying drugs for people with a first clinical attack suggestive of multiple sclerosis

Filippini¹,

Clerico²,

Beiki³

et al. 2016

Cochrane Database of Systematic Reviews

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Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: An Australian and New Zealand perspective Part 3 Treatment practicalities and recommendations

Cited by 21 publications

References 95 publications

The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews

The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: a Systematic Review of Reviews

Family planning, antenatal and post partum care in multiple sclerosis: a review and update

Treatment with disease modifying drugs for people with a first clinical attack suggestive of multiple sclerosis

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