Pharmacotherapy of multiple sclerosis in pregnant women Review article
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Published:
Mar 31, 2013
Keywords:
multiple sclerosis, pregnancy, pharmacotherapy
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Abstract
Multiple sclerosis affects in majority young people, especially young women. There are several publications indicating on increasing number of new multiple sclerosis cases with higher incidence in women. Immunomodulatory and immunosuppressant drugs are widely used in multiple sclerosis treatment. Questions arise whether pharmacotherapy of MS is safe and whether it can be used during pregnancy. In the article current knowledge about safety and probable fetal risk of available drugs is presented. Moreover, expert opinion and recommendations were expressed.
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References
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2. Elhami S.R., Mohammad K., Sahraian M.A. et al.: A 20-year incidence trend (1989-2008) and point prevalence (March 20, 2009) of multiple sclerosis in Teheran, Iran: a population-based study. Neuroepidemiology 2011; 36(3): 141-147.
3. Myhr K.M., Mellgren S.I.: Corticosteroids in the treatment of multiple sclerosis. Acta Neurol. Scand. 2009; 189: 73-80.
4. Burton J.M., O’Connor P.W., Hohol M., Beyene J.: Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Cochrane Database Syst. Rev. 2012; 12: CD006921.
5. Schardein J.L.: Chemically induced birth defects. Marcel Dekker Inc., New York 1993; 1(40): 307-313.
6. Gur Ch., Diav-Citrin O., Shechtman S. et al.: Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled study. Reprod. Toxicol. 2004; 18: 93-101.
7. Hoffman L.A., Kumpfel T., Heer I. et al.: Pregnancy and immunomodulatory therapy in multiple sclerosis patients. Nervenarzt 2006; 77: 663-668: 670.
8. Hellwig K., Beste Ch., Schimrigk S., Chan A.: Immunomodulation and postpartum relapses in patients with multiple sclerosis. Ther. Adv. Neurol. Dis. 2009; 2(1): 7-11.
9. Fragoso Y.D., Boggild M., Macias-Islas M.A. et al.: The effects of long-term exposure to disease modyfing drugs during pregnancy in multiple sclerosis. Clin. Neurol. Neurosurg. 2013; 115: 154-159.
10. Lu E., Wang B.W., Guimond C. et al.: Disease-modyfing drugs for multiple sclerosis in pregnancy. A systematic review. Neurology 2012; 79: 1130-1135.
11. Tsui A., Lee M.A.: Multiple sclerosis and pregnancy. Curr. Opin. Obstet. Gynecol. 2011; 23(6): 435-439.
12. Sandberg-Wollheim M., Frank D., Giesser B. et al.: Pregnancy outcomes during treatment with interferon beta-1a in patients with multiple sclerosis. Neurology 2005; 65: 802-806.
13. Boscovic R., Wande R., Wolpin J. et al.: The reproductive effects of interferon therapy in pregnancy: a longitudinal cohort. Neurology 2005; 65: 807-811.
14. Amato M.P., Portaccio E., Ghezzi A. et al.: Pregnancy and fetal outcomes after interferon-β exposure in multiple sclerosis. Neurology 2010; 75(20): 1794-1802.
15. Sandberg-Wollheim M., Alteri E., Moraga M.S., Kornmann G.: Pregnancy outcomes in multiple sclerosis following subcutaneous interferon beta-1a therapy. Mult. Scler. 2011; 17(4): 423-430.
16. Hellwig K., Gold R.: Glatiramer acetate and interferon-beta throughout gestation and postpartum in women with multiple sclerosis. J. Neurol. 2011; 258: 502-503.
17. Bartosik-Psujek H.: Ciąża i poród u chorych na stwardnienie rozsiane. NeuroRaport 2012; 1(1): 10-13.
18. De Santis M., Straface G., Cavaliere A.F. et al.: The first case of mitoksantron exposure in early pregnancy. Neurotoxicol. 2007; 28(3): 696-697.
19. Hellwig K., Schimrigk S., Chan A., Epplen J., Gold R.: A newborn with Pierre Robin sequence after preconceptional mitoksantron exposure of a female with multiple sclerosis. J. Neurol. Sci. 2011; 307(1-2): 164-165.
20. Sanofi Aventis US. Aubagio® (teriflunomid) [online].
21. Fragoso Y.D., Finkelsztejn A., Kaimen-Maciel D.R. et al.: Long-term use of glatiramer acetate by 11 pregnant women with multiple sclerosis: a retrospective multicenter case series. CNS Drugs 2010; 24(11): 969-976.
22. Lu E., Wang B.W., Guimond C., Synnes A. et al.: Safety of disease-modyfing drugs for multiple sclerosis in pregnancy: current challenges and future considerations for effective pharmacovigilance. Exp. Rev. 2013; 13(3): 251-260.
23. De Seze J., Chapelotte M., Delalande S. et al.: Intravenous corticosteroids in the postpartum period for reduction of acute exacerbations in multiple sclerosis. Mult. Scler. 2011; 10: 596-597.
24. Hellwig K., Beste Ch., Schimrigk S., Chan A.: Immunomodulation and postpartum relapses in patients with multiple sclerosis. Ther. Adv. Neurol. Disord. 2009; 2(1): 7-11.