Disease- modifying drugs in multiple sclerosis during breastfeeding: a review of current evidence

Introduction. Multiple sclerosis mainly affects women of childbearing age, and the pregnancy and postpartum period is of special interest because of the peculiarities of the disease course and the therapeutic consequences that derive from it. During the period of breastfeeding (BF), the choice of treatment strategy must weigh up the well-established benefits of BF for both the newborn and the mother against the safety profile and potential adverse effects on the infant resulting from exposure to disease-modifying drugs transferred through breast milk. Development. The study reviews the current evidence on the safety of disease-modifying drugs available for the treatment of multiple sclerosis during the BF period, and gathers data on the transfer of the different drugs into breast milk, as well as the potential adverse effects described in the infant. The drugs of first choice during this period are interferon beta and glatiramer acetate. The rest of the disease modifying drugs are not accepted for use in the BF period according to their summary of product characteristics. However, in recent years, data from studies of clinical practice and case series have been published suggesting that some of these drugs could be used safely during this period. Conclusions. Given the recognised health benefits of BF for both mother and infant, exclusive breastfeeding is recommended whenever possible. It is essential to carry out an individualised assessment prior to pregnancy and to evaluate the different treatment options depending on each patient.

Automated summary

Multiple sclerosis primarily affects women of childbearing age, making the pregnancy and postpartum period a topic of interest due to its impact on disease course and treatment considerations. This study reviews the safety of disease-modifying drugs during breastfeeding, including their transfer into breast milk and potential adverse effects on the infant. Interferon beta and glatiramer acetate are considered safe options during breastfeeding, while other drugs are not recommended. However, recent research suggests that some of these drugs may be used safely during this period.