Page 4 - Disease Modifying Drugs and Family Planning in MS

SUMMARY OF AUTHOR’S RECOMMENDATIONS FOR THE USE OF
DMDS IN ADVANCE OF, DURING, AND IN THE POSTPARTUM PERIOD

In advance During pregnancy, or if Postpartum/
of pregnancy unplanned pregnancy is breastfeeding
discovered
Possible use during pregnancy

Interferonß Safe to continue into pregnancy if clinically Safe to breastfeed
needed on treatment

Glatiramer acetate Generally considered safe in pregnancy, use if Breastfeed on
benefits to mother outweigh risk to foetus treatment only if
benefits clearly
outweigh risks

Natalizumab a Option for patient Can be used up to 30 weeks' Do not breastfeed
with high disease gestation for a patient with during treatment
activity planning a high MS activity
pregnancy

Dimethyl fumarate Short half life Not recommended, use only if Breastfeed on
facilitates benefits clearly outweigh risks treatment only if
withdrawal benefits clearly
outweigh risks
Contraindication during pregnancy
Fingolimod a,b 2 months washout Contraindicated - Do not breastfeed
before pregnancy withdraw treatment during treatment
should begin

Teriflunomide Consider switch to Contraindicated - Do not breastfeed
alternative DMD if stop treatment and during treatment
patient plans use rapid elimination
pregnancy soon procedure
(use rapid elimination
procedure)

Alemtuzumab C 4 months washout Use only if benefits Do not breastfeed
before pregnancy clearly outweigh risks for 4 months after
should begin the last dose

Cladribine tablets C 6 months washout Contraindicated, withdraw Do not breastfeed
before pregnancy any current treatment if for 10 days after the
should begin pregnancy occurs last dose

Ocrelizumab 12 months washout Avoid during pregnancy Discontinue
before pregnancy unless potential benefit breast-feeding
should begin to the mother outweighs while receiving
potential risk to the foetus ocrelizumab

a Risk of rebound activation of MS disease activity if treatment is withdrawn; consider bridging with another DMD that is safe to use in pregnancy, e.g. interferonß
b Contraindications also apply to siponimod, which is not indicated for use in relapsing–remitting multiple sclerosis in Europe (the washout period for siponimod is 10 days)
c Alemtuzumab and cladribine tablets are hypothesised to act as immune reconstitution inhibitors, which may provide an opportunity for longer-term planning of a pregnancy free of DMD
treatment or MS disease activity for the majority of patients (see text). Recommendations are compiled from labelling of DMDs, published articles, (see text for references) and authors’
clinical experience.

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(red = contraindicated, amber = warning/precaution, green = indicated)
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