Ms medication and pregnancy, ms-docblog

Desire to have children and MS is an important issue. In principle, all experts today agree that people with MS should be given intensive support on this topic. Everything should be done to ensure that you want to have children safely and smoothly despite MS. In the meantime, it should also be known that MS patients can become pregnant as well as those not affected. They also give birth to healthy children just as often, can usually give birth normally and can of course also – if needed – a person >

Nevertheless, there is always uncertainty about pregnancy and MS, which is often related to the (planned) MS medication. Most of the time it is about which drugs can be used safely and how best to proceed strategically. That is why I would like to briefly summarize the most important facts.

Basically, for all preparations (except Copaxone), the package insert states that you should not get pregnant with the medication in question. Most of the time, however, it also means that if you carefully weigh the benefits and risks, you can consider pregnancy despite medication.

Since maximum protection is also sought for the mother, it has become established to keep some of the preparations until the onset of pregnancy and only then to discontinue them. Since flare-ups are significantly reduced during pregnancy, this procedure usually has a good compromise between the health of the mother and protection of the unborn child from medication. This procedure is useful for all interferon preparations (Betaferon, Rebif, Avonex, Plegridy) and for dimethyl fumarate (Tecfidera), but is also carried out for glatitramer acetate (Copaxone), although this substance – as already mentioned above – has now been classified as unproblematic.

The procedure described above should not be used for teriflunomide (Aubagio) and fingolimod (Gilenya). Although the data on pregnancy among these preparations are surprisingly unremarkable, both preparations have at least a theoretical risk potential due to their mechanism of action. Therefore, both substances should be discontinued before conception. Teriflunomide (Aubagio) has the option of washing out the substance with cholestyramine if pregnancy occurs, which should also be done immediately. Fingolimod (Gilenya) should be stopped immediately if an unplanned pregnancy occurs.

Natalizumab (Tysabri) is a substance for the treatment of very active MS courses – if you stop the substance, the disease activity comes back. Since generally very active MS patients are treated with natalizumab, in recent years there has been a move towards passing on Tysabri during pregnancy in the interests of the mother’s health. Protection of pregnancy is often not enough for natalizumab patients: if the drug is discontinued when pregnancy occurs, it is not uncommon for episodes to occur during pregnancy, which is very stressful for everyone involved. The safety data available so far justify this procedure, whereby it must always be an individual decision (see also the contribution pregnancy with highly active MS).

If you got alemtuzumab, you can plan a pregnancy relatively well. You shouldn’t be in the first month after this Infusion cycle, but it is possible from the 4th month after infusion – the substance is no longer detectable in the body. In addition, after alemtuzumab, in the best case scenario, you also have rest before the illness and do not have to take any more medication for the time being – a favorable period to realize your desire to have children.

Taking cladribine requires safe contraception while taking tablets – in addition, half should be taken year after the last ingestion, no children are conceived, which applies to both men and women. Accordingly, you have to postpone your desire to have children for about 1.5 years if you choose cladribine as an MS drug. After that, however, the drug promises therapy-free remission for the following years. This is also a favorable situation for an existing desire to have children.

The situation is currently somewhat confusing for ocrelizumab (Ocrevus). The drug is very effective and has good safety data – so it is a very attractive concept for the treatment of relapsing MS patients. According to the European information leaflet, you should not get pregnant for 1 year after using ocrelizumab. Since ocrelizumab has to be given every 6 months, this means that you shouldn’t get pregnant at all if you are being treated with this drug – and of course that’s not pragmatic. In contrast, the American prescribing information states that you should not get pregnant for only 6 months. This is doable, because pregnancy shortly before the next cycle is then possible. Such a procedure then complies with the regulations and you can still treat with this innovative drug. It is to be hoped that the European technical information will be revised at some point.

These were the most important recommendations for MS medication and pregnancy. If anything is unclear about this important topic speak With your neurologist so that you can get these important questions answered clearly.

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Christina Cherry
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