What’s new in MS: teratogenicity of disease-modifying drugs, extended interval natalizumab dosing, a potential biomarker, the “MS hug,” and virtual reality therapy.
Advances in multiple sclerosis (MS) continue to dominate other therapeutic areas in neurology. MS presentations accounted for approximately 15% of the more than 3000 scientific presentations at the 71st American Academy of Neurology meeting in Philadelphia, PA, May 4 to 10, 2019.
Pregnancy outcome and disease-modifying therapies
Multiple sclerosis (MS) occurs more frequently in women, often during childbearing years. Although women with MS require no special gynecologic care during pregnancy, MS management requires close observation and possibly drug or dose adjustment. The Food and Drug Administration (FDA) has not approved any disease-modifying agent for use during pregnancy.
Ahmed and colleagues1 reviewed the outcome of 142 pregnancies in 120 women with MS. During 80 of the 142 pregnancies (56.3%), the fetus was exposed to a disease-modifying agent. The most common disease-modifying agents were beta interferons (35.2%), natalizumab (19.7%), fingolimod (16.9%), and dimethyl fumarate (3.5%). Premature birth occurred in 5% of the exposed group vs 3.2% of the nonexposed group (P=NS). The rate of abortions was also similar (10% in the exposed group vs 11.3% in the nonexposed group). Major fetal malformations did not occur in either group. In this observational study, there was no difference in pregnancy outcomes in pregnant women who received disease-modifying agents vs those who did not.
It is unlikely that there will ever be a definitive study comparing the potential teratogenicity of different disease-modifying agents for MS. Consequently, physicians and their patients must rely on retrospective and registry data. This study should reassure women who become pregnant while under treatment, but more data are needed before disease-modifying agents can be recommended as safe during pregnancy.
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