Table 4.

DMT use and family planning

DMT	Discontinuation before pregnancy	Use in pregnancy	Breastfeeding
glatiramer acetate	not necessary	compatible	compatible
INF-β	not necessary	compatible	compatible
dimethyl-fumarate / diroximel-fumarate	not necessary	contraindicated	contraindicated
teriflunomide	accelerated elimination	contraindicated	contraindicated
fingolimod	at least 2 months	contraindicated	contraindicated
siponimod	at least 10 days	contraindicated	contraindicated
ozanimod	at least 3 months	contraindicated	contraindicated
ponesimod	at least 1 week	contraindicated	contraindicated
cladribine	at least 6 months	contraindicated	7 days after the drug intake breastfeeding is compatible
natalizumab	not necessary	compatible in very active disease; stop at 30–34 GW; extended interval dosing (6 weeks)	compatible, no interval between infusion and next breastfeeding
ocrelizumab	until pregnancy	contraindicated	probably compatible, wait at least 4 h after infusion
ofatumumab	until pregnancy	contraindicated	compatible (except the first days after birth)
alemtuzumab	last dose 4 months before conception	contraindicated	probably compatible EMA: 4 months after the last infusion

based on SMPCs and Krysko et al. 2023 [25] abbreviations: EMA – European Medicine Agency, GW – gestational week