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Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region.
Neurol Ther. 2020 Jun 20 [Online ahead of print]NT

Abstract

Most disease-modifying drugs (DMDs) are contraindicated in pregnancy. Management of MS is especially challenging for pregnant patients, as withdrawal of DMDs leave the patient at risk of increased disease activity. We, a group of experts in MS care from countries in the Arab Gulf, present our consensus recommendations on the management of MS in these patients. Where possible, a patient planning pregnancy can be switched to a DMD considered safe in this setting. Interferon β now can be used during pregnancy, where there is a clinical need to maintain treatment, in addition to glatiramer acetate. Natalizumab (usually to 30 weeks' gestation for patients with high disease activity at high risk of relapse and disability progression) may also be continued into pregnancy. Cladribine tablets and alemtuzumab have been hypothesised to act as immune reconstitution therapies (IRTs). These drugs provide a period of prolonged freedom from relapses for many patients, but the patient must be prepared to wait for up to 20 months from initiation of therapy before becoming pregnant. If a patient becomes pregnant while taking fingolimod, and requires continued DMD treatment, a switch to interferon β or natalizumab after a variable washout period may be prescribed, depending on the level of disease activity. Women who wish to breastfeed should be encouraged to do so, and interferon β may also be used during breastfeeding. There is a lack of data regarding the safety of using other DMDs during breastfeeding.

Authors+Show Affiliations

Department of Medicine, Amiri Hospital, Sharq, Kuwait. alroughani@gmail.com.Department of Neurology, Rashid Hospital, Dubai, United Arab Emirates. Dubai Medical College, Dubai Health Authority (DHA), Dubai, United Arab Emirates.Neurology Unit, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.Neuroscience Department, Khoula Hospital, Muscat, Oman.Department of Neurology, American Center of Psychiatry and Neurology, Abu Dhabi, United Arab Emirates.Neuroscience Department, Khoula Hospital, Muscat, Oman.Neurology and Immunology Medical Affairs Gulf Region, Merck Serono Middle East FZ LTD, Dubai, United Arab Emirates.Department of Neurology (Neuroscience Institute), Hamad Medical Corporation, Doha, Qatar.Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.Neurology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32564333

Citation

Alroughani, Raed, et al. "Disease-Modifying Drugs and Family Planning in People With Multiple Sclerosis: a Consensus Narrative Review From the Gulf Region." Neurology and Therapy, 2020.
Alroughani R, Inshasi J, Al-Asmi A, et al. Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region. Neurol Ther. 2020.
Alroughani, R., Inshasi, J., Al-Asmi, A., Alkhabouri, J., Alsaadi, T., Alsalti, A., Boshra, A., Canibano, B., Ahmed, S. F., & Shatila, A. (2020). Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region. Neurology and Therapy. https://doi.org/10.1007/s40120-020-00201-8
Alroughani R, et al. Disease-Modifying Drugs and Family Planning in People With Multiple Sclerosis: a Consensus Narrative Review From the Gulf Region. Neurol Ther. 2020 Jun 20; PubMed PMID: 32564333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disease-Modifying Drugs and Family Planning in People with Multiple Sclerosis: A Consensus Narrative Review from the Gulf Region. AU - Alroughani,Raed, AU - Inshasi,Jihad, AU - Al-Asmi,Abdullah, AU - Alkhabouri,Jaber, AU - Alsaadi,Taoufik, AU - Alsalti,Abdullah, AU - Boshra,Amir, AU - Canibano,Beatriz, AU - Ahmed,Samar Farouk, AU - Shatila,Ahmed, Y1 - 2020/06/20/ PY - 2020/05/01/received PY - 2020/6/22/entrez PY - 2020/6/22/pubmed PY - 2020/6/22/medline KW - Breastfeeding KW - Disease-modifying drugs KW - Family planning KW - Multiple sclerosis KW - Pregnancy JF - Neurology and therapy JO - Neurol Ther N2 - Most disease-modifying drugs (DMDs) are contraindicated in pregnancy. Management of MS is especially challenging for pregnant patients, as withdrawal of DMDs leave the patient at risk of increased disease activity. We, a group of experts in MS care from countries in the Arab Gulf, present our consensus recommendations on the management of MS in these patients. Where possible, a patient planning pregnancy can be switched to a DMD considered safe in this setting. Interferon β now can be used during pregnancy, where there is a clinical need to maintain treatment, in addition to glatiramer acetate. Natalizumab (usually to 30 weeks' gestation for patients with high disease activity at high risk of relapse and disability progression) may also be continued into pregnancy. Cladribine tablets and alemtuzumab have been hypothesised to act as immune reconstitution therapies (IRTs). These drugs provide a period of prolonged freedom from relapses for many patients, but the patient must be prepared to wait for up to 20 months from initiation of therapy before becoming pregnant. If a patient becomes pregnant while taking fingolimod, and requires continued DMD treatment, a switch to interferon β or natalizumab after a variable washout period may be prescribed, depending on the level of disease activity. Women who wish to breastfeed should be encouraged to do so, and interferon β may also be used during breastfeeding. There is a lack of data regarding the safety of using other DMDs during breastfeeding. SN - 2193-8253 UR - https://www.unboundmedicine.com/medline/citation/32564333/Disease-Modifying_Drugs_and_Family_Planning_in_People_with_Multiple_Sclerosis:_A_Consensus_Narrative_Review_from_the_Gulf_Region L2 - https://dx.doi.org/10.1007/s40120-020-00201-8 DB - PRIME DP - Unbound Medicine ER -
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