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Review
. 2024 Aug;30(9):1093-1106.
doi: 10.1177/13524585241228103. Epub 2024 Mar 8.

Expert opinion on the use of contraception in people with multiple sclerosis

Jan Hillert  1 , Riley Bove  2 , Lisa B Haddad  3 , Kerstin Hellwig  4 , Maria Houtchens  5 , Melinda Magyari  6 , Gabriele S Merki-Feld  7 , Scott Montgomery  1   8 , Rossella E Nappi  9   10 , Egon Stenager  11   12 , Heidi Thompson  13 , Zeliha Tulek  14 , Elisabetta Verdun Di Cantogno  15 , Manuela Simoni  16
Affiliations
Review

Expert opinion on the use of contraception in people with multiple sclerosis

Jan Hillert et al. Mult Scler. 2024 Aug.

Abstract

Background: Current guidance on the selection of appropriate contraception for people with multiple sclerosis (PwMS) is lacking.

Objective: To address this gap, an expert-led consensus program developed recommendations to support clinicians in discussing family planning and contraception with women and men with multiple sclerosis (MS).

Methods: A multidisciplinary steering committee (SC) of 13 international clinical experts led the program, supported by an extended faculty of 32 experts representing 18 countries. A modified Delphi methodology was used for decision-making and consensus-building. The SC drafted 15 clinical questions focused on patient-centered care, selection of contraception, and timing of stopping/starting contraception and disease-modifying therapies (DMTs). Statements addressing each question were drafted based on evaluation of published evidence and the experts' clinical experience. Consensus was reached if ⩾75% of respondents agreed (scoring 7-9 on a 9-point scale) with each recommendation.

Results: Consensus was reached on 24 of 25 proposed recommendations, including how and when to discuss contraception, types and safety of contraceptives, and how to evaluate the most appropriate contraceptive options for specific patient groups, including those with significant disability or being treated with DMTs.

Conclusion: These expert recommendations provide the first practical, relevant, and comprehensive guidance for clinicians on the selection of contraception in PwMS.

Keywords: Multiple sclerosis; consensus; contraception; disease-modifying therapy; expert opinion; reproductive health.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.H. has received honoraria for serving on advisory boards for Biogen, Bristol Myers Squibb/Celgene, Janssen, Merck, Sandoz, and Sanofi-Genzyme and speaker’s fees from Biogen, Janssen, Novartis, Merck, Teva, Sandoz, and Sanofi-Genzyme. He has served as principal investigator for projects sponsored by, or received unrestricted research support from, Biogen, Bristol Myers Squibb/Celgene, Janssen, Merck, Novartis, Roche, and Sanofi-Genzyme. His MS research is funded by the Swedish Brain Foundation. R.B. has received research support from Department of Defense, National Institutes of Health, National MS Society, as well as Biogen, Novartis, and Roche Genentech; consulting and advisory board fees for Alexion, Biogen, EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Janssen, Genzyme Sanofi, Novartis, Roche Genentech, and TG Therapeutics. L.B.H. is employed by Population Council, a global non-profit with several contraceptive products in development or currently marketed globally. No other disclosures related to this work presented. K.H. has received personal compensation as a speaker/consultant from Bayer, Bristol Myers Squibb, Biogen, INC Research, Merck, Novartis, Roche, Teva, and Sanofi-Genzyme, and research funding from Biogen, Merck, Novartis, Roche, Sanofi-Genzyme, and Teva. M.H. has received research support from Genentech and Biogen. M.M. has served on scientific advisory boards for Sanofi, Novartis, and Merck, and has received honoraria for lecturing from Biogen, Merck, Novartis, Roche, Genzyme, and Bristol Myers Squibb. G.S.M.-F. has received personal compensation as a speaker/consultant from Novartis, Teva, Gedeon Richter, HRA Pharma, Lundbeck, and Merck. S.M. has received research support from Roche, Novartis, and AstraZeneca; received speaker’s honorarium from Teva; and served on a study advisory board for IQVIA. R.E.N. has past financial relationships (lecturer, member of advisory boards, and/or consultant) with Boehringer Ingelheim, Eli Lilly, Endoceutics, Gedeon Richter, Merck Sharpe & Dohme, Palatin Technologies, Procter & Gamble Co., TEVA Women’s Health Inc., and Zambon SpA. At present, she has ongoing relationships with Abbott, Astellas, Bayer HealthCare AG, Exceltis, Fidia, HRA Pharma, Merck, Novo Nordisk, Organon & Co., Pfizer Inc., Shionogi Limited, Theramex, and Viatris. E.S. declares that there is no conflict of interest apart from the funding of this project. H.T. has received honoraria and travel grants from Merck, Biogen Idec, and Novartis. Z.T. declares that there is no conflict of interest apart from the funding of this project. E.V.D.C. was an employee of EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, at the time of study. M.S. has received honoraria for lectures, advisory boards, and research grants from Merck and Ferring.

Figures

Figure 1.
Figure 1.
Overview of the modified Delphi process for achieving consensus (modified from Sørensen et al.). HCP: healthcare professional; PICo: population, interest, context; PICO: population, intervention, comparison, outcome; SC: steering committee. *A PICO/PICo framework was used for each question, to inform the systematic literature review.
See this image and copyright information in PMC

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