4.3 Review

Disease modifying therapy and pregnancy outcomes in multiple sclerosis: A systematic review and meta-analysis

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Cladribine and pregnancy in women with multiple sclerosis: The first cohort study

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Summary: The aim of this study was to investigate the effects of cladribine use on pregnancy outcomes and disease control in women with multiple sclerosis. The study found that although most newborns are healthy, women who used cladribine in the last 6 months before or after their last menstrual period still require reinforced contraception counseling.

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Kerstin Hellwig et al.

Summary: Interim results from this large registry suggest that early DMF exposure is not significantly associated with adverse pregnancy outcomes. The outcomes are consistent with previous smaller reports and with the general population.

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Multiple Sclerosis Disease Activity and Disability Following Discontinuation of Natalizumab for Pregnancy

Kerstin Hellwig et al.

Summary: This prospective cohort study found that 10% of women may retain clinically meaningful disability from pregnancy-related natalizumab cessation relapses 1 year post partum. This information should be shared with women on natalizumab who desire pregnancy to weigh the high risk of pregnancy-related relapses and disability to the partly uncertain risks of continuing natalizumab throughout pregnancy or switching to depleting agents before conception.

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Pregnancy, Fetal, and Infant Outcomes Following Maternal Exposure to Glatiramer Acetate During Pregnancy and Breastfeeding

Sigal Kaplan et al.

Summary: Published data support the safety of glatiramer acetate in pregnant or breastfeeding multiple sclerosis patients, with limited long-term data. This study aimed to assess pregnancy, fetal, and infant outcomes following maternal exposure to glatiramer acetate. The results suggest that maternal exposure to glatiramer acetate does not appear to be associated with adverse pregnancy, fetal, or infant outcomes, supporting the safety of both 20-mg/mL and 40-mg/mL glatiramer acetate treatments during pregnancy and breastfeeding.

DRUG SAFETY (2022)

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Anti-CD20 therapies for multiple sclerosis: current status and future perspectives

Monica Margoni et al.

Summary: Multiple sclerosis is a chronic disease affecting the central nervous system, and recent advancements in immune pathophysiology have led to the identification of selective B-cell-depleting therapies like anti-CD20 monoclonal antibodies, which have shown strong efficacy and safety in treating MS. This has expanded the therapeutic options for both relapsing and progressive MS patients, highlighting the important role of B cells in the disease process.

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Eighteen-month safety analysis of offspring breastfed by mothers receiving glatiramer acetate therapy for relapsing multiple sclerosis - COBRA study

Andrea Ines Ciplea et al.

Summary: This study assessed the safety outcomes for offspring breastfed by mothers undergoing glatiramer acetate (GA) treatment. The results showed that maternal intake of GA during breastfeeding did not adversely affect offspring safety outcomes assessed during the first 18 months of life.

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Pregnancy outcome following first-trimester exposure to fingolimod: A collaborative ENTIS study

Emmanuelle Pauliat et al.

Summary: This study investigated pregnancy outcomes after fingolimod use for multiple sclerosis, comparing them with interferon-beta-exposed pregnancies. It found a slightly higher rate of major congenital anomalies in the fingolimod group, but further studies are needed to definitively rule out this risk.

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Anti-CD20 therapies and pregnancy in neuroimmunologic disorders A cohort study from Germany

Tania Kuempfel et al.

Summary: This study investigated pregnancy outcomes and disease activity in women with MS, NMOSDs, and ONID after treatment with RTX/OCR. The findings suggest that although there may be increased risk of preterm birth with RTX/OCR exposure during pregnancy, more data is needed to fully understand potential risks and benefits.

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Prevalence of adverse pregnancy outcomes after exposure to interferon beta prior to or during pregnancy in women with MS: Stratification by maternal and newborn characteristics in a register-based cohort study in Finland and Sweden

Marta Korjagina et al.

Summary: This study aimed to describe the prevalence of adverse pregnancy outcomes among women with multiple sclerosis exposed to interferon-beta compared to those unexposed to any MS disease modifying drugs, and found that the prevalence of serious adverse pregnancy outcomes did not significantly differ between the two groups across various characteristics.

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Early Aggressive Treatment Approaches for Multiple Sclerosis

Alexandra Simpson et al.

Summary: This review provides a comprehensive analysis of current high-efficacy disease-modifying therapies for the treatment of multiple sclerosis (MS). It discusses both approved and emerging therapies for patients with different forms of MS, as well as treatment considerations in pediatric and pregnant populations. The review also covers the treatment paradigms of escalation and early aggressive approaches, with a focus on ongoing clinical trials comparing these strategies.

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Drug and Neurofilament Levels in Serum and Breastmilk of Women With Multiple Sclerosis Exposed to Natalizumab During Pregnancy and Lactation

Undine Proschmann et al.

Summary: This study observed women treated with natalizumab during pregnancy and lactation, finding that most patients did not experience disease activity during gestation and postpartum. Natalizumab concentration in breastmilk was low but detectable sNfL levels were present in most samples.

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Pregnancy-related relapses and breastfeeding in a contemporary multiple sclerosis cohort

Annette Langer-Gould et al.

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Monoclonal antibody treatment during pregnancy and/or lactation in women with MS or neuromyelitis optica spectrum disorder

Andrea Ines Ciplea et al.

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Safety of potential breast milk exposure to IFN-β or glatiramer acetate One-year infant outcomes

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Natalizumab during pregnancy and lactation

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Natalizumab during pregnancy and lactation

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MULTIPLE SCLEROSIS JOURNAL (2018)

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Pregnancy: Effect on Multiple Sclerosis, Treatment Considerations, and Breastfeeding

Rhonda Voskuhl et al.

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Glatiramer acetate during early pregnancy: A prospective cohort study

Sandra Herbstritt et al.

MULTIPLE SCLEROSIS JOURNAL (2016)

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Glatiramer acetate during early pregnancy: A prospective cohort study

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Transfer of Natalizumab into Breast Milk in a Mother with Multiple Sclerosis

Teresa E. Baker et al.

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Sandra Vukusic et al.

NATURE REVIEWS NEUROLOGY (2015)

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Alemtuzumab in the treatment of multiple sclerosis: key clinical trial results and considerations for use

Eva Havrdova et al.

THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS (2015)

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Rebecca S. Romero et al.

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Teriflunomide in the treatment of multiple sclerosis: current evidence and future prospects

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THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS (2014)

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Barry A. Singer

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Glatiramer acetate exposure in pregnancy: preliminary safety and birth outcomes

Heidi J. Salminen et al.

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Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study

C. Weber-Schoendorfer et al.

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