MS Family Planning 101: Should DMTs Be Discontinued Before and During Pregnancy?

Like many autoimmune diseases, multiple sclerosis (MS) affects twice as many women as men. The average patient will be diagnosed at age 30, right around the time when many are starting or growing their families. Pregnancy is not a risk to women with MS, and the rate of relapse during pregnancy actually tends to decrease. But the relapse rate goes up in the first 3 months after birth (Confavreux et al., 1998). While many disease-modifying therapies (DMTs) are available for patients diagnosed with relapsing forms of MS, all can pose a risk to the fetus, and none are indicated for use during pregnancy.

In an interview with MSDF, Bonnie W., a mom with relapsing-remitting MS (RRMS), expressed a fear common to many in her position: fear of disease progression while off therapy and the risk of permanent damage while trying to become pregnant. “[My husband and I] decided that we were ready for another baby, and then I had to stop [teriflunomide (Aubagio, Sanofi)],” she said. “I took a medicine to clear my system of the drug. And, so it’s been about 4 months and we’re still not pregnant. I’m not going to keep trying [to conceive] forever, because I want to get back on my meds.”

Indeed, the advice is for patients to stop taking all currently available DMTs for 1 or more months before becoming pregnant. Even though patients such as Bonnie know that none of the DMTs are 100% effective or curative, the drugs do reduce the risk of relapse and some other measures of disease progression. While patients and clinicians want to avoid causing damage to the fetus, this leaves patients trying to have a baby at risk for new relapses, at least until the poorly understood protective effects of pregnancy go into effect.

Elizabeth Crabtree-Hartman, M.D., sees about 1000 MS patients in her role as an associate clinical professor of neurology and the director of patient education and support at the UCSF Multiple Sclerosis Center. In an interview with MSDF she said, “Something that’s really important to keep in mind—and this is a good tip for community physicians—if a person is on DMT and thinking about pregnancy, if that person is taking oral contraceptives, it’s really important to discontinue the use of oral contraceptive pills and use a different means of birth control, while the person is on DMT, to establish a regular cycle while the person’s MS is still covered by the DMT, prior to doing a washout for pregnancy. Because the idea is that we want the person to be uncovered for as little time as possible.”

Continue Reading

.