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Review
. 2021;23(4):11.
doi: 10.1007/s11940-021-00666-4. Epub 2021 Mar 30.

Treatment of Women with Multiple Sclerosis Planning Pregnancy

Kristen M Krysko  1   2 , Riley Bove  1 , Ruth Dobson  3   4 , Vilija Jokubaitis  5   6 , Kerstin Hellwig  7
Affiliations
Review

Treatment of Women with Multiple Sclerosis Planning Pregnancy

Kristen M Krysko et al. Curr Treat Options Neurol. 2021.

Abstract

Purpose of review: We review data available for treatment of multiple sclerosis (MS) before, during, and after pregnancy. We present recent data on disease-modifying therapies (DMT) before/during pregnancy and while breastfeeding, with treatment recommendations.

Recent findings: Observational data support the safety of injectable DMTs (glatiramer acetate, interferon-beta) for use in pregnancy, while some oral DMTs might be associated with fetal risk. Monoclonal antibodies (mAbs) before pregnancy such as rituximab or natalizumab likely do not pose significant fetal risks, but can cross the placenta with neonatal hematological abnormalities if given in the second trimester or later. Breastfeeding is associated with decreased risk of postpartum relapses. Finally, injectables and mAbs likely have low transfer into breastmilk.

Summary: Many women with MS do not require DMTs during pregnancy, although injectables could be continued. For women with highly active MS, cell-depleting therapies could be given before conception, or natalizumab could be continued through pregnancy, with monitoring of the fetus. Women should be encouraged to breastfeed, and those with higher relapse risk could consider injectables or mAbs while breastfeeding. Further data on safety of DMTs around pregnancy are needed. Maximizing function through non-pharmacologic approaches is complementary to DMTs. Special considerations for pregnancy and DMTs during the COVID-19 pandemic are needed.

Keywords: COVID-19; Disease-modifying therapy; Lactation; Multiple sclerosis; Postpartum; Pregnancy.

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Conflict of interest statement

Conflict of InterestKristen M Krysko was funded by a Sylvia Lawry Physician Fellowship through the National Multiple Sclerosis Society (FP-1605-08753 (Krysko)). She also had fellowship funding through Biogen. Riley Bove is funded by a Harry Weaver Scholarship through the National Multiple Sclerosis Society. She has received recent research support from the National Multiple Sclerosis Society, the California Initiative to Advance Precision Medicine, the Hilton Foundation, the Sherak Foundation, the Weill Innovation Fund, the UCSF CTSI RAP program, and Akili Interactive. She has received consulting fees from Alexion, Biogen, EMD Serono, Genzyme Sanofi, Novartis, and Roche Genentech. Ruth Dobson works within the PNU, which is funded by Barts Charity. She receives grant support from the UK MS Society, Horne Family Charitable Trust, Biogen, Celgene, and Merck. She has received honoraria for Advisory boards and/or educational activities from Biogen, Teva, Sanofi, Merck, and Roche. Vilija Jokubaitis is funded by an MS Research Australia Fellowship (16-0206). She receives project grant support from the National Health and Medical Research Council (NHMRC) of Australia (GNT1156519) and MS Research Australia (18-0424; 19-0665). She has received honoraria from Biogen and Roche for non-promotional educational activities, and conference travel support from Merck and Roche. Kerstin Hellwig receives grant support from the Innovation Fund of the Federal Joint Committee. She has also received consultant and speaker honoraria and grant support from Bayer, Biogen, Merck, Novartis, Sanofi Genzyme, Roche, and Teva.

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