Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study

Nguyen, Ai-Lan; Havrdová, Eva; Horáková, Dana; Izquierdo, Guillermo; Kalinčík, Tomáš; Walt, Anneke van der; Terzı, Murat; Alroughani, Raed; Duquette, Pierre; Girard, Marc; Prat, Alexandre; Boz, Cavit; Sola, Patrizia; Ferraro, Diana; Lugaresi, Alessandra; Lechner‐Scott, Jeannette; Barnett, Michael; Grand’Maison, François; Grammond, Pierre; Ramo-Tello, Cristina; Türkoğlu, Recai; McCombe, Pamela A.; Pucci, Eugenio; Trojano, María; Granella, Franco; Spitaleri, Daniele; Pesch, Vincent Van; Soysal, Aysun; Oreja‐Guevara, Celia; Verheul, Freek; Vucic, Steve; Hodgkinson, Suzanne; Slee, Mark; Ampapa, Radek; Prevost, Julie; Menoyo, José Luis Sánchez; Skibina, Olga; Solaro, Claudio; Olascoaga, Javier; Shaw, Cameron; Madsen, Klaus Gregaard; Naidoo, Kimesh; Hyde, Robert; Butzkueven, Helmut; Jokubaitis, Vilija

doi:10.1016/j.msard.2019.01.003

Cited by 42 publications

(48 citation statements)

References 28 publications

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“…As shown in the MSBase registry, the number of pregnancies initiated while on DMDs has increased over the last 12 years. The median time of DMD exposure is 30 days, suggesting that most women interrupt treatment when pregnancy is confirmed [104]. Interrupting treatment because of a planned or confirmed pregnancy carries an increased risk of rebound of disease activity, which is particularly relevant when therapy with fingolimod and natalizumab is interupted.…”

Section: Medical Management and Patients' Daily Life Activitiesmentioning

confidence: 99%

State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis

et al. 2020

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The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.

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Section: Medical Management and Patients' Daily Life Activitiesmentioning

confidence: 99%

State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis

et al. 2020

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“…In the case of aggressive forms of the disease, other drugs should be used if the patient wishes a pregnancy. [ 6 ] The case, assessed in the light of clinical risk management, raises the question of more personalized information regarding patients desire for pregnancy (cognitive level, culture, family context).…”

Section: Discussionmentioning

confidence: 99%

Twin pregnancy outcome following teriflunomide treatment in a relapsing-remitting multiple sclerosis patient

D’Aleo

Rifici

Donato³

et al. 2020

Medicine

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Rationale: Teriflunomide is a disease-modifying drug that has been approved for treatment of relapsing-remitting multiple sclerosis. Due to its teratogenic effect in animals, however, it is not recommended during pregnancy. For this reason, effective contraception must be used during its administration. When an unscheduled pregnancy occurs during therapy, patients must undergo a cholestyramine procedure for rapid flushing of the drug. Patient concerns: We describe the case of a 35-year-old female patient suffering diagnosed with relapsing-remitting multiple sclerosis at the age of 20. The patient as a result of side effects of previous therapies started taking teriflunomide. Diagnosis: Despite recommendations for the use of contraceptives, the patient became pregnant during drug therapy. Pregnancy occurred 12 months after initiating teriflunomide treatment. Interventions: Therapy with teriflunomide was immediately suspended and cholestyramine was prescribed (8 g 3 times a day, for 11 days) to flush out any residual drug from the body. Outcomes: Despite an 8-week exposure to teriflumomide during gestation, the patient gave birth to healthy twin girls at 35 th week. Controls carried out after birth did not reveal any malformation or genetic and chromosomal abnormality. At a 5-month pediatric specialist check both babies were healthy and growing regularly. Conclusion: This shows that even if there is evidence of teratogenic effects in animals, an 8-week exposure to teraflunomide >0.02 mg/L did not have effects on the newborn.

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“…Interestingly, a recent retrospective study using an international MS pregnancy database found an increasing percentage of MS patients becoming pregnant on DMTs, rising from 27% in 2006 to 62% in 2016, with a median exposure duration of one month. The proportion of pre-term births or miscarriages compared to the unexposed pregnancies were no different [60]. Updated information on the safety of DMT use during pregnancy based from the FDA label, registry data and other sources may be found in the Supplementary Materials, Table S1 [15,16,17,18,19,30,31,46,57,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78].…”

Section: Pregnancymentioning

confidence: 99%

Women’s Health: Contemporary Management of MS in Pregnancy and Post-Partum

Tisovic

Amezcua

2019

Biomedicines

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Multiple sclerosis (MS) primarily affects women in childbearing age and is associated with an increased risk of adverse post-partum outcomes. Relapses and now fetal exposure to disease modifying treatments in the early phase of pregnancy and thereafter are of concern. Safe and effective contraception is required for women who wish to delay or avoid pregnancy while on disease-modifying treatments. Counseling and planning is essential to assess the risk of both fetal and maternal complications, particularly now in the era of highly efficient and riskier therapies. The purpose of this review is to provide a practical framework using the available data surrounding pregnancy in MS with the goal of optimizing outcomes during this phase in MS.

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Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study

Cited by 42 publications

References 28 publications

State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis

State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis

Twin pregnancy outcome following teriflunomide treatment in a relapsing-remitting multiple sclerosis patient

Women’s Health: Contemporary Management of MS in Pregnancy and Post-Partum

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