Kinderwunsch bei Multipler Sklerose

ZUSAMMENFASSUNG

Eine Multiple Sklerose (MS) tritt meist im reproduktionsfähigen Alter auf. Deshalb ist die Frage der Familienplanung bei Patienten mit MS von großer Bedeutung. Die Datenlage zu den krankheitsmodifizierenden Therapien (DMT) im Hinblick auf Familienplanung, Schwangerschaft und Stillzeit wächst, auch wenn viele Fragen nicht eindeutig beantwortet werden können.

ABSTRACT

Multiple sclerosis (MS) usually occurs at reproductive age. Therefore, the issue of family planning is of great importance for patients with MS. The data available on disease-modifying therapies (DMT) regarding family planning, pregnancy and breastfeeding is growing, even though many questions cannot be answered unequivocally.

Schlüsselwörter

Fortpflanzung - Schwangerschaft - Stillen - krankheitsmodifizierende Therapie - Register

Key words

Reproduction - pregnancy - breast feeding - disease modifying treatment - registries

• Literatur

• 1 Confavreux C, Hutchinson M, Hours MM. et al Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med 1998; 339: 285-291
• 2 Cavalla P, Rovei V, Masera S. et al Fertility in patients with multiple sclerosis: current knowledge and future perspectives. Neurol Sci 2006; 27: 231-239
• 3 Landi D, Portaccio E, Bovis F. et al ECTRIMS. 2019 Abstract 338
• 4 Portaccio E, Moiola L, Martinelli V. et al Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: II: Maternal risks. Neurology 2018; 90: e832-e839
• 5 Bayer. Fachinformation Betaferon^® 250 Mikrogramm/ml. Stand Oktober 2019
• 6 Biogen. Fachinformation AVONEX^® 30 Mikrogramm/0,5 ml Injektionslösung im Fertigpen. Stand September 2019
• 7 Merck. Fachinformation Rebif^® 44 Mikrogramm/0,5 ml Injektionslösung in einer Patrone. Stand September 2019
• 8 KKMS, Krankheitsbezogenes Kompetenznetz Multiple Sklerose. Qualitätshandbuch MS/NMOSD. Empfehlungen zur Therapie der Multiplen Sklerose/Neuromyelitis-optica-Spektrum-Erkrankungen für Ärzte. Im Internet https://www.kompetenznetz-multiplesklerose.de/wp Stand: 30.10.2019
• 9 Hellwig K, Neudorfer O, Melamed-Gal S. et al Pregnancy outcomes in patients with multiple sclerosis and exposure to branded glatiramer acetate during all three trimesters. ECTRIMS 2017: P765
• 10 Teva. Fachinformation COPAXONE PEN^® 40 mg Injektionslösung im Fertigpen. Februar 2019
• 11 Weber-Schoendorfer C, Schaefer C. Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study. Mult Scler 2009; 15: 1037-1042
• 12 Vattulainen P, Burkii S, Geissbuehler Y. et al Prevalence of infant outcomes at birth after exposure to interferon beta prior to or during pregnancy: a register-based cohort study in Finland and Sweden among women with MS. ECTRIMS 2019: P1144
• 13 Juuti R, Hakkarainen KM, Burkill S. et al No increased risk of spontaneous abortion and ectopic pregnancy after exposure to interferon-beta prior to or during pregnancy: results from registerbased Nordic study among women with MS. Eur J Neurology 2019; 26 (Suppl. 01) 240 #EPR2074
• 14 Biogen. Fachinformation Tecfidera^® Stand Juli 2019
• 15 Everage NJ, Jones CC, Hellwig K. et al Pregnancy outcomes from an international registry of patients treated with delayed-release dimethyl fumarate. ECTRIMS 2018: P603
• 16 Genzyme, Sanofi. Fachinformation Aubagio^® Stand Mai 2019
• 17 Vukusic S, Coyle PK, Jurgensen S. et al Pregnancy outcomes in patients with multiple sclerosis treated with teriflunomide: Clinical study data and 5 years of post-marketing experience. Mult Scler 2019 Apr 10. doi: 10.1177/1352458519843055
• 18 Montalban X, Gold R, Thompson AJ. et al ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler 2018; 25: 215-237
• 19 Schneider H, Miller RK. Receptor-mediated uptake and transport of macromolecules in the human placenta. Int J Dev Biol 2010; 54: 367-375
• 20 Genzyme, Sanofi. Fachinformation Lemtrada^® Stand April 2019
• 21 Roche. Fachinformation MabThera^® SC. Stand Juli 2019
• 22 Roche. Fachinformation Ocrevus^® Stand Juni 2019
• 23 Sanofi-Aventis Deutschland. Rote-Hand-Brief Alemtuzumab (Lemtrada). April 2019
• 24 Merck. Fachinformation Mavenclad^® Juli 2018
• 25 Giovannoni G, Comi G, Rammohan K. et al Long-term disease stability assessed by the Expanded Disability Status Scale in patients treated with Cladribine Tablets in the CLARITY and CLARITY Extension studies. ECTRIMS 2019 Abstract EP1573
• 26 ClincialTrials.gov Identifier: NCT03745144. Effects of Cladribine Tablets on the Pharmacokinetics of Microgynon^® Im Internet: https://clinicaltrials.gov/ct2/show/NCT03745144 Stand: 25. Juli 2019
• 27 Galazka A, Nolting A, Cook S. et al Pregnancy outcomes during the clinical development programme of cladribine in multiple sclerosis (MS): an integrated analysis of safety for all exposed patients. ECTRIMS 2017: P1874
• 28 Novartis Pharma GmbH. Rote-Hand-Brief Fingolimod (Gilenya^® vom 2. September 2019
• 29 Novartis. Fachinformation Gilenya^® Stand September 2019
• 30 Lopez Leon S, Geissbuehler Y, Moore A. et al Effect of fingolimod on pregnancy outcomes in patients with multiple sclerosis. ECTRIMS 2019: P411
• 31 Biogen. Fachinformation Tysabri^® Stand August 2018
• 32 Ray JG, Vermeulen MJ, Bharatha A. et al Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes. JAMA 2016; 316: 952-961
• 33 Kümpfel T, Thiel S, Meinl I. et al Anti CD20 therapies and pregnancy in neuroimmunological disorders – a case series from Germany. ECTRIMS 2018: P688
• 34 Park-Wyllie L, Mazzotta P, Pastuszak A. et al Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62: 385-392
• 35 Ciplea AI, Thiel S, Gold R. et al Schwangerschaft und multiple Sklerose. Neurologie 2019; 2: 397-403
• 36 Michel L, Foucher Y, Vukusic S. et al Increased risk of multiple sclerosis relapse after in vitro fertilisation. J Neurol Neurosurg Psychiatry 2012; 83: 796-802