ArticleNeurology(R) neuroimmunology & neuroinflammation2023
Multiple Sclerosis Disease Activity and Disability Following Cessation of Fingolimod for Pregnancy.
Article in Neurology(R) neuroimmunology & neuroinflammation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- UK consensus on pregnancy in multiple sclerosis: An update to 'Association of British Neurologists' guidance.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Review
- Discontinuation of ocrelizumab in multiple sclerosis: reoccurrence of disease activity.Journal of neurology, neurosurgery, and psychiatry · 2026Observational
- Controversies in neuroimmunology: Multiple sclerosis and other demyelinating disordersBiomedica : revista del Instituto Nacional de Salud · 2026Review
- Multiple Sclerosis in Women: Impact of Different Life Stages on Treatment Decisions.CNS drugs · 2026Review
- Maternal Multiple Sclerosis and Offspring's Developmental and Behavioral Profile: A Case-control Study.Current neuropharmacology · 2026Article
- Intrapartum Care for Women with Multiple Sclerosis: A JBI-Guided Scoping Review and Evidence Synthesis of Clinical Practices and Maternal Outcomes.International journal of women's health · 2026Review
- Is therapy-free remission a realistic goal with cladribine tablets in multiple sclerosis? New insights into the mechanism of action and clinical implications of immune reconstitution with cladribine tablets in MS therapy.Journal of neurology · 2025Review
- Pregnancy-Related Disease Outcomes in Women With Moderate to Severe Multiple Sclerosis Disability.JAMA network open · 2025Article
- Treatment Strategies and Disease Activity During Pregnancy and Postpartum: Real-World Data From the Swiss Multiple Sclerosis Cohort.Neurology. Clinical practice · 2025Article
- Pregnancy and Infant Outcomes in Women With Multiple Sclerosis Treated With Ocrelizumab.Neurology(R) neuroimmunology & neuroinflammation · 2025Article
- Impact of disease-modifying therapies on pregnancy outcomes in multiple sclerosis: a prospective cohort study from the German multiple sclerosis and pregnancy registry.The Lancet regional health. Europe · 2025Article
- [XVI Post-ECTRIMS Meeting: review of the new developments presented at the 2023 ECTRIMS Congress (II)].Revista de neurologia · 2024Article
- Holistic, Long-Term Management of People with Relapsing Multiple Sclerosis with Cladribine Tablets: Expert Opinion from France.Neurology and therapy · 2024Review
- Sex impacts treatment decisions in multiple sclerosis.Journal of neurology · 2024Article
- Clinical and radiological implications of subpotent generic fingolimod in multiple sclerosis: a case series.Therapeutic advances in neurological disorders · 2024Article
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveDiscontinuation of fingolimod ≥2 months before pregnancy is recommended to minimize potential teratogenicity. The magnitude of MS pregnancy relapse risk, particularly severe relapses, after fingolimod cessation is unclear, as is whether this risk is reduced by pregnancy or modifiable factors.
methodsPregnancies who stopped fingolimod treatment within 1 year before or during pregnancy were identified from the German MS and Pregnancy Registry. Data were collected through structured telephone-administered questionnaires and neurologists' notes. Severe relapses were defined as a ≥2.0 increase in Expanded Disability Status Scale (EDSS) or new or worsening relapse-related ambulatory impairment. Women who continued to meet this definition 1 year postpartum were classified as reaching the Severe Relapse Disability Composite Score (SRDCS). Multivariable models accounting for measures of disease severity and repeated events were used.
resultsOf the 213 pregnancies among 201 women (mean age at pregnancy onset 32 years) identified, 56.81% (n = 121) discontinued fingolimod after conception. Relapses during pregnancy (31.46%) and the postpartum year (44.60%) were common. Nine pregnancies had a severe relapse during pregnancy and additional 3 during the postpartum year. One year postpartum, 11 of these (6.32% of n = 174 with complete EDSS information) reached the SRDCS. Adjusted relapse rates during pregnancy were slightly higher compared with the year before pregnancy (relapse rate ratio = 1.24, 95% CI 0.91-1.68). Neither exclusive breastfeeding nor resuming fingolimod within 4 weeks of delivery were associated with a reduced risk of postpartum relapses. Most pregnancies relapsed during the first 3 months postpartum (n = 55/204, 26.96%). DISCUSSION: Relapses during pregnancy after fingolimod cessation are common. Approximately 6% of women will retain clinically meaningful disability from these pregnancy-related, fingolimod cessation relapses 1 year postpartum. This information should be shared with women on fingolimod desiring pregnancy, and optimizing MS treatment with nonteratogenic approaches should be discussed.
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