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
Alemtuzumaba,b	Maintain contraception for 4 months after the end of the second-year treatment coursec.
Cladribine tabletsa	Maintain contraception for 6 months after the end of the second-year treatment course.
Dimethyl fumarate	No recommendation given on washout period.
Fingolimoda	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.
Natalizumaba	No recommendation given on washout period.
Ocrelizumaba	Maintain contraception for 12 months after the end of the second-year treatment course.
Siponimoda	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.