Pregnancy and the Use of Disease-Modifying Therapies in Patients with Multiple Sclerosis: Benefits versus Risks

Raed Alroughani 1, Ayse Altintas 2, Mohammed Al Jumah 3, Mohammadali Sahraian 4, Issa Alsharoqi 5, Abdurahman AlTahan 6, Abdulkader Daif 7, Maurice Dahdaleh 8, Dirk Deleu 9, Oscar Fernandez 10, Nikolaos Grigoriadis 11, Jihad Inshasi 12, Rana Karabudak 13, Karim Taha 14, Natalia Totolyan 15, Bassem I Yamout 16, Magd Zakaria 17, Saeed Bohlega 18

Affiliations

01 January 2016

-

doi: 10.1155/2016/1034912

Abstract

The burden of multiple sclerosis (MS) in women of childbearing potential is increasing, with peak incidence around the age of 30 years, increasing incidence and prevalence, and growing female : male ratio. Guidelines recommend early use of disease-modifying therapies (DMTs), which are contraindicated or recommended with considerable caution, during pregnancy/breastfeeding. Many physicians are reluctant to prescribe them for a woman who is/is planning to be pregnant. Interferons are not absolutely contraindicated during pregnancy, since interferon-β appears to lack serious adverse effects in pregnancy, despite a warning in its labelling concerning risk of spontaneous abortion. Glatiramer acetate, natalizumab, and alemtuzumab also may not induce adverse pregnancy outcomes, although natalizumab may induce haematologic abnormalities in newborns. An accelerated elimination procedure is needed for teriflunomide if pregnancy occurs on treatment or if pregnancy is planned. Current evidence supports the contraindication for fingolimod during pregnancy; data on other DMTs remains limited. Increased relapse rates following withdrawal of some DMTs in pregnancy are concerning and require further research. The postpartum period brings increased risk of disease reactivation that needs to be carefully addressed through effective communication between treating physicians and mothers intending to breastfeed. We address the potential for use of the first- and second-line DMTs in pregnancy and lactation.

Conflict of interest statement

The authors declare that they have no competing interests.

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