Page 7 - Disease Modifying Drugs and Family Planning in MS

DISCONTINUING A DMD AND AVOIDING REBOUND MS ACTIVATION

Washout periods vary between different DMDs. Based on labelling and clinical experience,
the following intervals were recommended between withdrawal of DMDs and becoming
pregnant. This list does not include those agents which can be continued into pregnancy if
needed, see Table 1)

Alemtuzumab

4 months (but can be used in pregnancy if clinically justified)

Cladribine tablets Fingolimod Siponimod Ocrelizumab

6 months 2 months 10 days 6-12 months

Lymphopenia occurring during the first 3 months of treatment with fingolimod has
been proposed as a possible marker of patients at most risk of MS reactivation following
the withdrawal of this agent

Teriflunomide: Plasma levels of teriflunomide must be < 0.02 mg/l before pregnancy can
be initiated. Unaided, this takes 8 months, on average, but can be achieved in 11 days using
the rapid elimination procedure

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