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Women’s Health: Underprescribed Medications & Why

by Dr. Priya Deshmukh - Senior Editor, Health
written by Dr. Priya Deshmukh - Senior Editor, Health

The Silent Disparity in MS Treatment: Why Women Are Being Left Behind and What the Future Holds

For women with multiple sclerosis (MS), a disturbing reality is emerging: they are significantly less likely to receive disease-modifying therapies (DMTs), even when their disease severity is comparable to men. A recent study published in Neurology reveals that women face an 8% lower chance of starting any DMT and a staggering 20% lower chance of accessing highly effective DMTs (HE-DMTs). This isn’t simply a matter of differing disease presentation; it’s a systemic gap in care with potentially devastating long-term consequences.

The Gender Gap in MS Care: A Deep Dive into the Data

The study, analyzing data from over 22,600 patients with relapsing-remitting MS in France between 1997 and 2022, paints a concerning picture. While pregnancy is a factor – treatment often pauses during pregnancy and postpartum – it doesn’t fully explain the disparity. Researchers found that these differences appeared within the first 1-2 years of diagnosis and persisted for at least a decade. Women with MS also experienced higher relapse rates and were less frequently prescribed newer, more potent DMTs like S1PR modulators and anti-CD20s.

“This loss of chance is not acceptable anymore,” emphasizes Dr. Sandra Vukusic, lead investigator from the University of Lyon. “There are drugs that are compatible with pregnancy or can continue to fight the disease long after people stop them when they are trying to conceive.” The implications are clear: delayed or inadequate treatment can accelerate disability progression and diminish quality of life for women living with MS.

Beyond Pregnancy: Unpacking the Root Causes

While the study highlights the impact of pregnancy considerations, experts believe a complex interplay of factors contributes to this gender gap. Clinician bias, stemming from historical concerns about DMT safety during pregnancy (many of which have been alleviated by newer research), is a likely culprit. Furthermore, a lack of awareness regarding updated guidelines for safe DMT use in women of childbearing age may also play a role.

Expert Insight: “We’ve seen a historical tendency to err on the side of caution with women, particularly regarding medications with potential reproductive effects,” notes Dr. Emily Carter, a neurologist specializing in MS at the Cleveland Clinic (source: interview with Dr. Carter, July 2024). “However, the risks of untreated MS, including long-term disability, often outweigh the potential risks associated with carefully managed DMT use.”

Future Trends: Personalized Medicine and Proactive Intervention

Looking ahead, several key trends are poised to reshape MS treatment and potentially address this gender disparity:

1. The Rise of Personalized DMT Selection

The “one-size-fits-all” approach to MS treatment is fading. Advances in biomarkers and genetic testing are enabling clinicians to predict individual responses to different DMTs. This personalized approach could help identify the most effective treatment for each patient, regardless of gender, maximizing efficacy and minimizing side effects.

2. Enhanced Telemedicine and Remote Monitoring

Telemedicine is expanding access to specialized MS care, particularly for patients in rural or underserved areas. Remote monitoring technologies, such as wearable sensors and digital symptom tracking apps, can provide continuous data on disease activity and treatment response, allowing for proactive adjustments to therapy. This is particularly important for women who may face logistical challenges accessing frequent in-person appointments.

3. AI-Powered Decision Support Tools

Artificial intelligence (AI) is being developed to assist clinicians in making informed treatment decisions. AI algorithms can analyze vast datasets of patient data to identify patterns and predict treatment outcomes, potentially mitigating unconscious bias and ensuring equitable access to care.

Did you know? Research suggests that women with MS are more likely to report fatigue and cognitive dysfunction than men, symptoms that can significantly impact quality of life and may be undertreated.

Addressing the Gap: Actionable Steps for Patients and Providers

Closing the treatment gap requires a concerted effort from both patients and healthcare providers:

  • For Patients: Be proactive in discussing your treatment options with your neurologist. Don’t hesitate to ask about the latest research on DMT safety during pregnancy and postpartum. Advocate for your own care and seek a second opinion if you feel your concerns are not being adequately addressed.
  • For Providers: Stay up-to-date on the latest guidelines for MS treatment in women, including those related to pregnancy and reproductive health. Actively address potential biases in your clinical decision-making. Utilize shared decision-making approaches, involving patients in the selection of their treatment plan.

Pro Tip: Prepare a list of questions for your neurologist before your appointment. This will help you make the most of your time and ensure you receive the information you need to make informed decisions about your care.

The Role of Research and Advocacy

Continued research is crucial to better understand the underlying causes of the gender disparity in MS treatment and to develop more effective therapies. Advocacy organizations, such as the National Multiple Sclerosis Society, play a vital role in raising awareness, funding research, and advocating for policies that promote equitable access to care.

Key Takeaway: The under-treatment of women with MS is a critical issue that demands immediate attention. By embracing personalized medicine, leveraging technology, and fostering open communication between patients and providers, we can ensure that all individuals with MS receive the care they deserve.

Frequently Asked Questions

Q: Is it safe to take DMTs if I am planning to become pregnant?

A: Many DMTs are now considered safe to use during pregnancy or can be safely paused and resumed around conception. Discuss your plans with your neurologist to determine the best course of action for your individual situation.

Q: What if my neurologist is hesitant to prescribe a DMT due to my gender?

A: Seek a second opinion from another MS specialist. You have the right to receive evidence-based care that is tailored to your needs.

Q: How can I find more information about MS and treatment options?

A: The National Multiple Sclerosis Society (https://www.nationalmssociety.org/) and the Multiple Sclerosis Association of America (https://mymsaa.org/) are excellent resources.

What are your thoughts on the future of MS treatment and the challenges facing women with the disease? Share your perspective in the comments below!

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Health

MS Drug Use During Pregnancy: New Evidence

by Alexandra Hartman Editor-in-Chief
written by Alexandra Hartman Editor-in-Chief


Breakthrough: New Data Supports Ms Treatment During Pregnancy, Shifting to Proactive Care

Table of Contents

Phoenix – Groundbreaking research provides compelling evidence supporting the use of potent disease-modifying therapies (dmts) during pregnancy for women battling active multiple sclerosis (MS). This marks a significant shift toward proactive treatment strategies.

Two recent observational studies-one focusing on the anti-CD20 monoclonal antibody ofatumumab and the other on the integrin receptor antagonist natalizumab-offer a solid foundation for a more proactive approach. The Goal Is To Treat Pregnant Women With Active Ms.This Is Especially Iif The Potential Benefits To The Mother Outweigh the Risks.

The Imperative Of informed Decisions In Ms Care During Pregnancy

Dr. Riley M. Bove, associate Professor Of Neurology At The University Of California San Francisco, Stressed That A “we-Don’t-Know” Stance Is No Longer Acceptable When Counseling Pregnant Women With Active Disease. She Emphasized That Current Evidence Can Guide Treatment Decisions.

While knowledge gaps persist regarding the specific risks of DMTs to fetal progress and pregnancy outcomes, it’s clear that women with active MS risk harm if left untreated.

Experts now advocate for leveraging available data, even if observational, to guide decisions affecting both maternal and fetal well-being. The new data on ofatumumab and natalizumab exemplifies this approach.

Ofatumumab: Real-World pregnancy Outcomes

An ongoing registry has documented ofatumumab exposure in 669 pregnancies.Of these, 221 cases reported before 2023 allowed for assessing both short- and long-term outcomes. First-trimester exposure was most common (87%).

While adverse outcomes occurred, including spontaneous abortions (12.6%), preterm births (9.6%),and minor congenital malformations in two infants,these rates align with those in the general population,noted Dr. Bove. Such data becomes invaluable when balancing treatment decisions against the known risks of active MS, which can cause irreversible brain injury in the mother.

Did You Know? A Study Published In “The Lancet Neurology” In Early 2024 Showed That Untreated Ms During Pregnancy Can Lead To A 40% Increase In The Risk Of Postpartum Relapses.

Natalizumab: A 16-Year tracking Study

Natalizumab Data, Presented As A Late-Breaking Abstract At Cmsc, Showed Results From A 16-Year Study. The Study Showed No Elevated Risk Of Adverse Pregnancy Outcomes While Seeing Significant Improvements In Ms Disease Management.

According To Katrina Bawden,Fnp-C,At The Rocky mountain Ms Clinic,The Clinic Has Followed 58 Pregnancies In 43 Women Since 2008. The Tracking Included Women Who Stopped Natalizumab Upon Learning Of Their Pregnancy And Those Who Continued Treatment Into The Third Trimester.

Impact Of Natalizumab Continuation On Ms Disease Activity

Among The 38 Pregnancies Were Natalizumab Was Discontinued, 13 Women Experienced Clinical Relapses, and Four Showed New Lesions On Mri. Conversely, No Relapses Or Mri Evidence Of Disease activity Occurred In The 20 Pregnancies Where Treatment Continued.

Pregnancy complications, including one fetal malformation and 10 miscarriages, were observed.However, Ms. Bawden Pointed Out That These Numbers Mirror General Population Rates. Notably, All Three Fetal Deaths Occurred In Women Who Discontinued Natalizumab. All Ten Women Who Miscarried Had Subsequent Healthy, Full-Term Deliveries While Remaining On Natalizumab.

These findings Have Prompted Clinicians At The Rocky Mountain Ms Clinic To Reassess The Risk-Benefit Ratio Of Natalizumab Use during Pregnancy.

Pro Tip: Always Consult With A Neurologist And Obstetrician To Create A Personalized Treatment Plan.Early Intervention Can Substantially Improve Outcomes For Both Mother And Child.

Evolving Treatment Protocols For Ms And Pregnancy

According To ms. Bawden, “Women At The Rocky Mountain Ms Clinic Who Become Pregnant While treated With Natalizumab Are Now Given The Option Of Continuing Natalizumab Every 8 Weeks Throughout Pregnancy, With The Last dose Scheduled At 34 Weeks’ Gestation.” This Decision Is Made Using Shared Decision-Making Regarding Ms Treatment.

Challenging “Illogical Guidance” In Ms Treatment

Caring For Pregnant Women With Ms Presents Complex Challenges Due To Incomplete Data. Dr.Bove, Co-Author Of A 2024 Paper On Dmt Risk-Benefit Assessment During Pregnancy, Argues That Strict Adherence To Drug Labeling Isn’t Always Clinically Sound.

she Notes That Current Recommendations Are Frequently enough Inconsistent, Differ Between Regulatory Agencies (Fda Versus European Medicines Agency), And Fail To Reflect The Latest Scientific advances, Leading To “Illogical” Guidance.

Ms Treatment Recommendations For Pregnancy Are Continuously Changing,Shaping clinical Strategies And Making It Essential For Clinicians To Stay informed. Updated Evidence Is Key to Decisions On Treating Active Disease During Pregnancy, Restarting Therapy Post-Pause, and Weighing Dmt Benefits And Risks for Breastfeeding Mothers.

Balancing Maternal And Fetal Health In Ms Treatment

While “First, do No Harm” Has Traditionally Prioritized Fetal Risk In Ms Treatment Decisions During Pregnancy, Dr. Bove Highlights The potential Harm To The Mother From Withholding Treatment.She Urges Balanced Discussions Considering Risks To Both Mother And Fetus.

Comparative Data: Key Outcomes of Ms Treatments During Pregnancy

Treatment Registry/Study Adverse Outcomes Disease Control
Ofatumumab Ongoing Registry (669 Pregnancies) Spontaneous Abortions (12.6%), Preterm Births (9.6%), Minor Congenital Malformations (2 infants) – Consistent With General Population Rates N/A
Natalizumab Rocky Mountain Ms Clinic (16 Years, 58 Pregnancies) Complications (1 Fetal Malformation, 10 Miscarriages) – Consistent With General Population Rates; All Fetal Deaths In Discontinuation group No Relapses or Mri Activity In Continued Treatment Group; Relapses And new Lesions in Discontinuation Group

Understanding Ms And Pregnancy: An Evergreen Perspective

Managing Multiple Sclerosis During Pregnancy Requires A Nuanced Approach That Considers The Health Of Both Mother And Baby. Here Are Some Key Considerations:

  • Shared Decision-Making: Engage In Open Dialog With Your Healthcare Team.
  • Individualized Treatment Plans: Treatment Should Be Tailored To Your Specific Needs.
  • Continuous Monitoring: Regular Check-Ups And Mri Scans Are Crucial.
  • Lifestyle Adjustments: Maintain A Healthy Lifestyle Through Diet, Exercise, And Stress Management.

By Staying Informed And Proactive, Women With Ms Can Navigate Pregnancy Successfully And Maintain Their Quality Of Life. Recent advances In Ms Treatment Offer Hope For Better Outcomes And Improved Maternal Health.

Frequently Asked Questions About Ms Treatment during Pregnancy

  1. What Are The Primary Concerns Regarding Ms Treatment During pregnancy?
    The Main concerns Are The Potential Risks Of Dmts To Fetal Development And Pregnancy Outcomes.However, Untreated Active Ms Can Also Pose Significant Risks To The Mother.
  2. How Do Clinicians Balance The Risks And Benefits Of Ms Treatment During Pregnancy?
    Clinicians Weigh The Potential Adverse Effects Of Dmts Against The risks Of Active Ms,Such As Irreversible brain Injury,Using Available Observational Data And Shared Decision-Making.
  3. What Role Does natalizumab Play in Ms Treatment During Pregnancy?
    Natalizumab Has Shown Promise In Controlling Ms Disease Activity during Pregnancy Without Increasing The Risk Of Adverse Pregnancy Outcomes. Clinicians Are Reevaluating Its Use Based On Long-Term Tracking Data.
  4. How Frequently enough Should Women With Ms Be Monitored during Pregnancy?
    Regular Monitoring Is Crucial To Track Disease Activity And adjust Treatment Plans As Needed. The Frequency Of Check-ups And Mri Scans Should Be Determined By Your Healthcare Team.
  5. Where Can I Find More Information About Ms And Pregnancy?
    Consult With your Neurologist, Obstetrician, And Reputable Medical Resources. Patient advocacy Groups Such As The National Multiple Sclerosis Society Also Offer Valuable Information.

What Are Your Thoughts On These Findings? Share Your Experiences Or Questions In The Comments Below.

Disclaimer: This Article is For Informational Purposes Only And Does Not Constitute Medical Advice. Always Consult With A Qualified Healthcare Professional For Personalized Guidance.

What are the potential long-term effects of various MS medications on both the mother and child during pregnancy, and how are researchers addressing these concerns?

MS Drug Use During Pregnancy: New Evidence & Safety Considerations

Managing multiple sclerosis (MS) while pregnant requires careful consideration of both the mother’s health and the developing fetus. Navigating the complexities of MS drugs during pregnancy can be challenging,as the potential benefits of controlling MS symptoms must be balanced against the possible risks to the unborn child.Recent research continually updates our understanding of this crucial intersection. This article explores the latest findings on MS medications during pregnancy and provides essential details for women considering or expecting a baby while living with MS, focusing on multiple sclerosis treatments, pregnancy and MS management, and the impact of various disease-modifying therapies (dmts).

The Challenge of Treating MS in Pregnancy

Pregnancy itself can change the course of MS. Some women may experiance a decrease in relapses (often in the second and third trimesters), while others might face an increased risk of relapse in the postpartum period. The complexities of pregnancy and MS necessitate a tailored approach. The primary concern is whether to continue with, modify, or wholly stop MS treatments. The decision-making process will depend on the specific MS drug, the stage of pregnancy, the severity of the MS, and the patient’s overall health. The National MS Society offers excellent resources and guidance on this topic.

Risks and Benefits of MS Medications

Choosing the right path requires understanding the potential risks and benefits of each MS medication. Some drugs, like teriflunomide, are strictly contraindicated due to documented teratogenic effects, leading to pregnancy risks. Other options might be safer during certain trimesters, but always require careful risk-benefit assessment. Many doctors recommend that patients attempt to discontinue treatments before conception while some treatments will need to be considered throughout the pregnancy, which increases the chances of relapse. The decision is complex and should always be made in consultation with a neurologist specializing in MS and a high-risk obstetrician.

Specific MS Drugs & Pregnancy: A Detailed Look

Knowing the safety profiles of specific MS drugs during pregnancy is pivotal to informed decision-making. The tables below summarize key information on several commonly used disease-modifying therapies (DMTs). LSD keywords include: *MS treatments during pregnancy*, *safety of MS medications*, *pregnancy with multiple sclerosis treatments.*

MS Drug (DMT) Pregnancy Category (FDA) Considerations & Recommendations Relapse Risk
Glatiramer Acetate (Copaxone, Glatopa) B Generally considered safe.Limited evidence of risk, and data suggests that it does not cross the placenta in significant amounts. Lower Risk
Interferon Beta (Avonex, Rebif, Plegridy) C Use with caution.Data supporting its safety is limited, and adverse effects are reported. Discuss with your doctor about waiting until the second or third trimester. Potential risk, depends on personal situation and therapy
Dimethyl Fumarate (Tecfidera) C Safety not fully established. While some studies have indicated no increased risk, there are not enough definitive results at this point. Potential risk, discuss with your doctor about waiting.
Natalizumab (Tysabri) C Limited data, but some reports of complications. Usually stopped during the pregnancy period, except for cases of highly active MS. High risk,depends on personal situation and therapy
Fingolimod (Gilenya) C High risk of embryo toxicity in animal studies. Should always be stopped before pregnancy and washout period must be considered. High risk, depends on personal situation and therapy
Ocrelizumab (Ocrevus) C Should be stopped before pregnancy and washout period must be considered. High risk, depends on personal situation and therapy

Vital Note: The FDA pregnancy categorizations are a general guide and don’t represent absolute safety. Consulting with qualified healthcare professionals is crucial for making informed decisions.

Postpartum Considerations and Relapse Management

The postpartum period poses a significant risk for MS relapse. Understanding how to best manage this can prevent major health issues post-delivery. Postpartum MS is a time of elevated risk. recent studies suggest that most relapses occur in the months following childbirth, particularly in patients who discontinue MS medications before or during pregnancy. Strategies to minimize risk include continuing the MS treatment if possible, resuming therapy as soon as the baby is stable and the mother gives the go-ahead with the advice of a doctor who is an MS Specialist.

Breastfeeding and MS Medications

Decisions about breastfeeding will depend on the MS medication and available data. Ideally,breastfeeding is encouraged while still taking care of the mother’s health. Some MS medications may be considered safe while breastfeeding, while others should be avoided. Consulting with a physician and a lactation consultant if possible is essential.

Practical Tips for Planning Pregnancy with MS

Planning for pregnancy with MS can go smoothly with proper preparation and awareness. Here are some practical tips for women considering pregnancy: Real-world examples also helps to personalize these suggestions and build trust with the reader. *MS planning pregnancy* key terms.

  • Consultation and Planning: Work closely with your neurologist and an obstetrician to develop a pre-conception plan.
  • Medication Review: Review all existing medications, including MS treatments. It’s critical to determine if MS medications being used are safe to continue during pregnancy.
  • Disease Activity: Assess current disease activity and discuss your risk of relapse. Be prepared to modify, discontinue, or change medications.
  • folic Acid Supplementation: Start taking prenatal vitamins, especially ones containing folic acid.
  • Lifestyle Adjustments: Ensure a healthy lifestyle, including diet, exercise, and proper rest, which is important for overall health and can help in managing MS symptoms.

Research Updates & future Directions

The field of MS drug use during pregnancy is evolving. Researchers are actively studying the long-term effects of various medications and their effects on both the mother and the child.These studies’ goals are to refine treatment guidelines and provide more specific and safe options for women. The continuous data on disease-modifying therapies and pregnancy risks is key. Ongoing research is focused on improving safety and understanding the long-term impact of treatments.

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