Update on reproductive safety of current and emerging disease-modifying therapies for multiple sclerosis

Cree, Bruce A.C.

doi:10.1177/1352458512471880

Cited by 65 publications

(65 citation statements)

References 22 publications

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“…At least 12 disease-modifying therapies (DMTs) have received FDA approval, and a few have been developed as oral medications (37)(38)(39). However, the financial burden of individual therapy can range upward to $60K annually (37), and side effects still reduce compliance and thereby overall efficacy (38).…”

Section: Clinical Studiesmentioning

confidence: 99%

Endogenous Opioids in the Etiology and Treatment of Multiple Sclerosis

Zagon

McLaughlin

2017

Multiple Sclerosis: Perspectives in Treatment and Pathogenesis

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Endogenous opioids are enkephalins and endorphins that are primarily produced in the brain and have multiple actions throughout the body. Enkephalins and endorphins act at opioid receptors and their activity can be blocked by opioid antagonists. A small pentapeptide termed opioid growth factor (OGF), and chemically termed [Met 5 ]-enkephalin, has been shown to have causative and therapeutic roles in experimental autoimmune encephalomyelitis (EAE), the animal model of multiple sclerosis (MS). Enkephalin levels are reduced in animals and humans during MS relapses, and may play a role in etiology. Exogenous therapy with OGF or endogenous stimulation of OGF by low dosages of naltrexone (LDN) reverse the course of progressive EAE and limit the number of relapses in relapsingremitting EAE. Individuals prescribed LDN report less fatigue and a better quality of life while using LDN. This chapter summarizes the information from studies using two different animal models of EAE, as well as two different treatment regimens of two different compounds-OGF or LDN. In all investigations, the presence of enkephalins resulted in beneficial effects.

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Section: Clinical Studiesmentioning

confidence: 99%

Endogenous Opioids in the Etiology and Treatment of Multiple Sclerosis

Zagon

McLaughlin

2017

Multiple Sclerosis: Perspectives in Treatment and Pathogenesis

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“…Nevertheless, the increasing number of pregnancy registries supply empirical data that aid decision making in individual situations. Table 4 provides an overview of the available information on teratogenicity, fertility, passage into breast milk and the placenta, and breastfeeding (33)(34)(35)(36).…”

Section: Pregnancymentioning

confidence: 99%

“…Treatments for multiple sclerosis during pregnancy and breastfeeding (35,36) There are insufficient data on daclizumab. For the latest recommendations on treatment of MS during pregnancy and the breastfeeding period, the reader is referred to the regularly updated expert consensus of the Competence Network Multiple Sclerosis (www.kompetenznetz-multiplesklerose.de).…”

Section: Tablementioning

confidence: 99%

Interdisciplinary Risk Management in the Treatment of Multiple Sclerosis

Havla¹,

Warnke²,

Kappos³

et al. 2016

Deutsches Ärzteblatt International

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“…All three oral MS medications (fingolimod, dimethyl fumarate, teriflunomide) are known to be detectable in animal breast milk. 11 In terms of relapse risk, the decision to breastfeed versus restarting MS therapy after delivery is complex, as patients must weigh increased risk for postpartum relapse off of therapy with the putative protective benefits of breastfeeding. However, exclusive breastfeeding typically requires a patient to remain off of DMTs, and thus the risks and benefits of these highly personal decisions must be made on an individual basis.…”

mentioning

confidence: 99%

Exploring Patients’ Knowledge and Misconceptions about Multiple Sclerosis and Pregnancy

Wesley¹,

Fabian²,

Krieger³

2016

US Neurology

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Multiple sclerosis (MS) is a lifelong neurologic disease affecting the central nervous system and resulting in demyelination and axonal loss over time. Symptoms are widely variable and often involve motor and sensory impairment, vision loss, gait disturbance, cognitive dysfunction, and fatigue. Furthermore, MS is a disease common to women of childbearing age, with 70% of patients being women and with 90% of patients presenting between the ages of 15 and 50.1 Family planning must be taken into account at time of diagnosis and when discussing which disease modifying agent to employ. Accurate knowledge and understanding of family planning issues is important for best outcomes.The relationship between pregnancy and relapse outcomes is complex and Education about peripartum concerns is also paramount. In a study of 461 women with MS, there was a higher rate of caesarian section; however, these findings represented a concurrently higher rate of planned, rather than emergency, caesarian sections, 5 a finding that might reflect an overly cautious approach. Previous practice advocated for caesarian sections to avoid pelvic floor trauma and thus exacerbation of preexisting urinary frequency and bladder control issues; however, it was shown in a study of 273 women in 2006 that urinary incontinence postpartum was more related to duration and severity of MS and not method of delivery. AbstractMultiple sclerosis (MS) has a high incidence in women of childbearing age. Accurate understanding of family planning matters is crucial for best outcomes. Methods: Thirty-seven women with MS aged 18 to 50 completed an anonymous questionnaire at an MS Center in New York City. There were 22 questions pertaining to four main categories: effect of pregnancy on MS, effect of MS on pregnancy, MS medication safety during pregnancy and breastfeeding, and effect of MS on offspring. Results: Mean age of patients was 36 years (standard deviation [SD] ±5.6); 86% had relapsing-remitting (RRMS). Mean time since diagnosis was 6.7 years (SD±5.2); 30.6% had been pregnant since diagnosis. Average correct score was 32.8% (SD±20.3), and while higher in patients who had been pregnant since diagnosis, 40.5% (SD±24.7) versus 31.3% (SD±17.9), there was no statistically significant difference; p=0.21. Largest knowledge deficit pertained to effect of MS on reproduction: average score 27.7% (SD±10.1). Only 21.0% knew that relapses can be treated with steroids during pregnancy; 50.0% of those with prior pregnancy knew this fact. Thirtyfour percent of patients on disease-modifying therapies (DMTs) reported not consistently using birth control. Conclusions: Our data identified misconceptions on important reproductive topics. It is important that providers educate effectively their patients on matters of reproduction.

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Update on reproductive safety of current and emerging disease-modifying therapies for multiple sclerosis

Cited by 65 publications

References 22 publications

Endogenous Opioids in the Etiology and Treatment of Multiple Sclerosis

Endogenous Opioids in the Etiology and Treatment of Multiple Sclerosis

Interdisciplinary Risk Management in the Treatment of Multiple Sclerosis

Exploring Patients’ Knowledge and Misconceptions about Multiple Sclerosis and Pregnancy

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