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ECTRIMS 2022 | Challenging clinical decisions in pregnancy planning with MS and NMOSD patients

Melinda Magyari, MD, PhD, The Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, shares examples of challenging clinical decisions in counseling pregnant patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). For example, suppose a patient with MS has high disease activity and is treated with a high-efficacy drug that causes rebound. In that case, it will be challenging to withdraw the drug before conception due to the risk of rebound. Therefore, pregnancy counseling before conception is extremely important to avoid using those drugs; luckily, there are alternatives in the MS space. In NMOSD, most immunosuppressants are contraindicated in pregnancy except azathioprine. Although azathioprine crosses the placenta, it doesn’t get converted into an active metabolite due to the absence of metabolizing enzymes in the fetus. However, NMOSD is associated with severe relapses, which require treatment with corticosteroids, plasmapheresis, and IVIg, thus making NMOSD pregnancies more challenging than MS pregnancies. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress 2022 in Amsterdam, The Netherlands.

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