Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

Abstract

More than half of all patients with multiple sclerosis (MS) in the Kingdom of Saudi Arabia (KSA) are women of childbearing age. Raising a family is an important life goal for women in our region of the world. However, fears and misconceptions about the clinical course of relapsing-remitting MS (RRMS) and the effects of disease-modifying drugs (DMDs) on the foetus have led many women to reduce their expectations of raising a family, sometimes even to the point of avoiding pregnancy altogether. The increase in the number of DMDs available to manage RRMS and recent studies on their effects in pregnancy have broadened management options for these women. Interferon beta now has an indication in Europe for use during pregnancy (according to clinical need) and can be used during breastfeeding. Glatiramer acetate is a further possible option for women with lower levels of RRMS disease activity who are, or about to become, pregnant; natalizumab may be used up to 30 weeks in patients with higher levels of disease activity. Where possible, physicians need to support and encourage women to pursue their dream of a fulfilling family life, supported where necessary by active interventions for RRMS that are increasingly evidence based.

Expert Narrative Review of the Safety of Cladribine Tablets for the Management of Relapsing Multiple Sclerosis

“…A medical writer (Dr Mike Gwilt, GT Communications) provided editorial assistance, funded by Merck Serono, Lyon France, an affiliate of Merck KGaA, Darmstadt, Germany. to individualised risk:benefit considerations [99][100][101][102]). Withdrawal of DMT leaves the patient at risk of MS disease reactivation or, in the case of fingolimod or natalizumab, potentially severe rebound MS activity [103,104].…”

“…Although the results of pregnancies in women (or their partners) exposed to CladT near or within the contraindicated period are reassuring, it is important to follow labelling requirements that women or men receiving this treatment ensure that no pregnancy occurs during and for at least 6 months following the last CladT dose, as recommended [ 23 ]. Family planning is a major issue for women with MS and their families [ 99 – 102 ]. MS per se does not adversely affect pregnancy outcomes, but most DMTs are contraindicated or subject to precautions relating to their use at this time (interferon and glatiramer acetate may be continued into pregnancy, and most experts support the use of natalizumab to 30 weeks’ gestation, subject to individualised risk:benefit considerations [ 99 – 102 ]).…”

“…Family planning is a major issue for women with MS and their families [ 99 – 102 ]. MS per se does not adversely affect pregnancy outcomes, but most DMTs are contraindicated or subject to precautions relating to their use at this time (interferon and glatiramer acetate may be continued into pregnancy, and most experts support the use of natalizumab to 30 weeks’ gestation, subject to individualised risk:benefit considerations [ 99 – 102 ]). Withdrawal of DMT leaves the patient at risk of MS disease reactivation or, in the case of fingolimod or natalizumab, potentially severe rebound MS activity [ 103 , 104 ].…”

The Place of Immune Reconstitution Therapy in the Management of Relapsing Multiple Sclerosis in France: An Expert Consensus

“…All DMTs except beta-interferons and glatiramer acetate are either contraindicated (including cladribine tablets), or subject to warnings regarding their use in pregnancy (including alemtuzumab), according to their European labelling [ 75 ]. According to their European Summary of Product Characteristics, patients are advised to delay pregnancy for 6 months after completing treatment with cladribine tablets and for 4 months after completing treatment with alemtuzumab, i.e.…”

Fármacos modificadores de la enfermedad en la esclerosis múltiple durante la lactancia: revisión de la evidencia actual

“…Algunos expertos en enfermedad inflamatoria intestinal también consideran que el uso es seguro durante la lactancia [ 54 , 59 , 60 ]. Por otro lado, algunas de las guías de práctica clínica [ 12 , 14 , 18 , 21 , 61 ], así como las agencias reguladoras del medicamento [ 62 , 63 ], recomiendan interrumpir la LM durante el tratamiento.…”