Treatment of multiple sclerosis during pregnancy – safety considerations

ABSTRACT

Introduction: Women with multiple sclerosis (MS) are treated early in the disease course with disease modifying therapies (DMT). Updated information is needed on pregnancy outcomes of DMT-exposed pregnancies and the effect of the drug withdrawal on MS disease activity.

Areas covered: In this review, we will cover the most important updated management strategies in planning a pregnancy when having MS.

Expert opinion: MS itself does not increase the risk of adverse pregnancy outcomes and does not negatively influence the long-term course of the disease. As MS became a treatable disease, management of DMTs before, during and after pregnancy is important. This requires updated knowledge on safety of DMTs as well as data of the effect on disease activity after drug withdrawal. A special challenge is the handling of women with highly active MS, as pregnancy might not be powerful enough to suppress the risk of rebound relapses. Exclusive breastfeeding is an option for many women who want to do so, but in cases of high disease activity and those women who do not want to breastfeed, early reintroduction of MS therapies should be considered.

KEYWORDS:

• Abortion
• adverse events
• fetal abnormalities
• teratogenetic effects

Article highlights

• Pregnancies do not worsen the long term course of the disease and accumulation of disability but may even show protective effects against disability accrual.

• Clinical management should be individualized to optimize both pregnancy outcome and MS disease course.

• So far we have robust data that IFN-β and GLAT do not have to be withdrawn before pregnancy.

• In cases of high disease activity depleting antibodies or the continuation of NTZ during pregnancy is a potential option.

• Exclusive breastfeeding may be beneficial in women with mild/moderate disease. In women with highly active foregoing nursing and resuming medications as soon as possible may be necessary.

• Given the unknown risks associated with DMT-exposure in utero, establishment of pregnancy registries, ideally with prospective enrollment, is essential.

This box summarizes key points contained in the article.

Declaration of interest

K Hellwig has been supported by the German Research Council Deutsche Forschungsgemeinschaft and has received speaker honoraria and research support from Almirall, Biogen Idec, Teva Genzyme Sanofi Aventis, Novartis, Bayer Healthcare and Merck Serono. R Gold has received payments for consultancy from Biogen and Teva; speaker honoraria and research grants from Biogen Idec Germany, Teva, Sanofi-Aventis, Novartis, Bayer Healthcare, and Merck Serono. J Thone has nothing to declare. S Thiel has nothing to disclose. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.