Multiple Sclerosis - Episode 5
Fred Lublin, MD, describes the typical patient with multiple sclerosis (MS) as a young woman who is planning to have children. He explains that MS affects women more than men by a ratio of approximately 3:1, but young men with MS may also be planning families. Subsequently, there must be discussions about family planning because, as a general rule, states Lublin, individuals should not be taking MS medications if they’re trying to conceive. The majority of MS medications are pregnancy category C, meaning that their teratogenicity is unknown. Glatiramer acetate is considered category B, and thus there is less concernregarding its use during pregnancy. Lublin stresses that patients and neurologists must weigh the risks against the benefitstogether. Patricia K. Coyle, MD, also recommends that neurologists partner with OBGYNs.
Lublin explains that pregnancy itself is protective against MS relapses, and with each subsequent trimester, this degree of protection increases. Consequently, there are relatively few MS-related problems during pregnancy. He states that neurologists do not regularly treat their patients during pregnancy with any disease-modifying therapies.However, during the 3-month postpartum period, the increased risk of flare-ups dictates the need for resuming disease-modifying therapies following delivery.
Coyle discusses the current perspectives related to the need for washout of disease-modifying therapies before becoming pregnant. She comments that the concerns using therapies during pregnancy must be balanced with the severity of a patient’s MS.There remains a dearth of experience with the use of the newer oral agents during pregnancy, but these and all the agents are being assessed through pregnancy registries.
She explains that several studies are focusing on men with MS who are fathering children.Coyle explains that there is little concern with using most disease-modifying therapies in men. The one exception is teriflunomide, which does get into the semen at very low levels, and currently has a category X pregnancy rating based on animal models in which it was found to be teratogenetic. She describes strategies for reducing risks, including barrier contraception and blood test for teriflunomide levels. She reiterates that this is the single MS disease-modifying therapy where some thought needs to be given with regard to the male MS patient.