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Review
. 2025 Jul;22(4):e00620.
doi: 10.1016/j.neurot.2025.e00620. Epub 2025 Jun 21.

Impact of sex on multiple sclerosis therapy

Patricia K Coyle  1
Affiliations
Review

Impact of sex on multiple sclerosis therapy

Patricia K Coyle. Neurotherapeutics. 2025 Jul.

Abstract

Multiple sclerosis (MS) is a female predominant disease. The prototypic affected individual is a young woman of childbearing age. This article emphasizes the current thinking about this disease, using a sex-based approach. It begins with a review of male vs. female differences in the nervous system and immune system, as well as a general discussion of sex hormones. The demographic and clinical impact of sex on MS prognosis and symptoms is covered. Pregnancy, the best studied sex-based condition, is reviewed and includes updated counseling information on fertility and assisted reproductive technology. MS issues in less well studied areas involving puberty, the menstrual cycle and menopause are also presented. The impact of sex on the MS therapeutic response is considered. The final section covers MS considerations in males. This up to date review provides a comprehensive and succinct approach to sex considerations in MS.

Keywords: Breastfeeding in MS; MS and pregnancy; MS and sex.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Patricia K. Coyle reports a relationship with Caremark LLC that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Amgen Inc that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Eli Lilly and Company that includes: consulting or advisory. Patricia K. Coyle reports a relationship with EMD Serono Inc that includes: consulting or advisory. Patricia K. Coyle reports a relationship with GSK that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Horizon Therapeutics USA Inc that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Novartis that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Sanofi that includes: consulting or advisory and funding grants. Patricia K. Coyle reports a relationship with TG Therapeutics Inc that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Viatris that includes: consulting or advisory. Patricia K. Coyle reports a relationship with Celgene that includes: funding grants. Patricia K. Coyle reports a relationship with Cleveland Clinic that includes: funding grants. Patricia K. Coyle reports a relationship with CorEvitas LLC that includes: funding grants. Patricia K. Coyle reports a relationship with Genentech Roche that includes: funding grants. Patricia K. Coyle reports a relationship with National Institute of Neurological Disorders and Stroke that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

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