Family Planning for People with Multiple Sclerosis in Saudi Arabia: an Expert Consensus

Table 1

Practical considerations relating to the use of disease-modifying drugs before and during pregnancy, according to European labelling.

DMD	Potential for use before and during pregnancy
Alemtuzumab^a,b	Maintain contraception for 4 months after the end of the second-year treatment course^c.
Cladribine tablets^a	Maintain contraception for 6 months after the end of the second-year treatment course.
Dimethyl fumarate	No recommendation given on washout period.
Fingolimod^a	Maintain contraception for 2 months after the last dose. Withdraw immediately if pregnancy is discovered.
Glatiramer acetate	No recommendation given on washout period.
Interferon beta	Can be continued into pregnancy if clinically needed.
Natalizumab^a	No recommendation given on washout period.
Ocrelizumab^a	Maintain contraception for 12 months after the end of the second-year treatment course.
Siponimod^a	Maintain contraception for 10 days after the last dose. Withdraw immediately if pregnancy is discovered.
Teriflunomide	Women should not become pregnant until plasma levels of teriflunomide are <0.02 mg/L (average 11 days if the accelerated elimination procedure is used, 8–24 months if not). Withdraw immediately if pregnancy is discovered (use accelerated elimination procedure).

^aHigh-efficacy DMD (see reference [19]). ^bCan be used in pregnancy if clinically justified (benefits to mother outweigh risks to the foetus). Collated from European Summaries of product Characteristics (available at http://www.medicines.org.uk/, accessed October 2020). See text for differences from US Prescribing Information.