This protocol addresses a specific, high-stakes clinical situation: women with multiple sclerosis who have persistent high disease activity and are pregnant — whether planned or unplanned. Balancing ongoing disease control with pregnancy introduces considerations that require a tailored treatment approach.

Clinical Scenario

For women with persistent high disease activity, delaying pregnancy is generally advised. For those who, despite this advice, still decide to become pregnant or have an unplanned pregnancy, the need for continued disease management during pregnancy must be carefully addressed.

Treatment Approach (Partial Overview)

Continued disease-modifying therapy during pregnancy may be warranted in this setting. The choice of agent and the timing relative to conception differ depending on whether the pregnancy is ongoing or planned — with strict timing requirements applying in certain cases. The complete decision algorithm is available in the full protocol.

References

DOI: 10.1177/1352458517751049

For women with persistent high disease activity, it would generally be advised to delay pregnancy.
For those who, despite this advice, still decide to become pregnant or have an unplanned pregnancy:
Treatment with natalizumab throughout pregnancy may be considered after full discussion of potential implications.
Treatment with alemtuzumab could be an alternative therapeutic option for planned pregnancy in very active cases, provided that a 4-month interval is strictly observed from the latest infusion until conception.

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Treatment of Multiple Sclerosis with Persistent High Disease Activity in Women Who Are Pregnant or Have an Unplanned Pregnancy

Clinical Scenario

Treatment Approach (Partial Overview)

References