AAN 2022 | Managing MS relapses during pregnancy

Kristen Krysko, MD, University of California San Francisco, San Francisco, CA, outlines emerging data on the management of multiple sclerosis (MS) during pregnancy. The protective state of pregnancy allows for most therapies to be stopped, but clinicians usually want to start women on treatment during the postpartum phase due to the evidence suggesting increased relapse rates in this time. Positive safety data has been released indicating that platform injectables, such as interferon-beta, can be considered during pregnancy and breastfeeding. However, these are not strong medications, so they are unable to protect women from postpartum relapses. Oral and infusion therapies, such as dimethyl fumarate, have also been suggested to be safe to continue until a positive pregnancy test, but not during breastfeeding. Lastly, clinicians can time the infusions of monoclonal antibodies pre-pregnancy to reduce the exposure of the fetus, with these therapies also showing emerging safety during breastfeeding. There are certain instances where continuing a certain treatment (e.g., natalizumab) is highly recommended throughout pregnancy due to the risk of rebound relapses. All these factors must be considered to optimize treatment using disease modifying therapies in light of pregnancy. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.