How Should We Manage Multiple Sclerosis Therapies During Pregnancy?

In a large cohort, investigators identify optimal strategies to reduce relapse risk in pregnant women with MS.

Pregnancy in women with multiple sclerosis (MS) often necessitates changes in disease-modifying therapy (DMT). Such DMT management may influence relapse risk (NEJM JW Neurol Oct 10 2023 "https://www.jwatch.org/na56552/2023" and Neurol Neuroimmunol Neuroinflamm 2023; 10:e200161). In this multicenter, retrospective cohort study using data from 6341 pregnancies in 4988 women with relapsing-onset MS, researchers assessed the effects of DMT management strategies on annualized relapse rate (ARR) during preconception, gestation, and postpartum periods.

The main findings were as follows:

DMT management during pregnancy significantly increased relapses during gestation (causal rate ratio [cRR], 1.13) and postpartum (cRR, 1.08).
The most deleterious effe…

Reviewing Author

Robert T. Naismith, MD

Disclosures

Consultant/Advisory BoardAlexion Pharmaceuticals; Amgen; Astoria; Biogen; Bristol Myers Squibb; Celltrion; Genentech; Hoffmann-La Roche; Genzyme; EMD Serono; Immpact-Bio; Immunic Therapeutics; Kyverna; Lundbeck; Novartis; Sandoz; TG Therapeutics

Grant/Research SupportNational Institutes of Health; National Multiple Sclerosis Society; U.S. Department of Defense

Leadership Positions in Professional SocietiesConsortium of Multiple Sclerosis Centers (Treasurer)

Robert T. Naismith, MD

Disclosures

Grant/Research SupportNational Institutes of Health; National Multiple Sclerosis Society; U.S. Department of Defense

Leadership Positions in Professional SocietiesConsortium of Multiple Sclerosis Centers (Treasurer)

How Should We Manage Multiple Sclerosis Therapies During Pregnancy?

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Reviewing Author