Version July 2025
| Disease-modifying therapy | Length of disease-modifying therapy washout period per label | Length of disease-modifying therapy washout period per pharmacokinetic/ pharmacodynamic placental transfer and potential risks | Characteristics |
| Self-injectable therapies (platform) | |||
| Interferons beta (all brand formulations approved for multiple sclerosis treatments and any generic equivalents) | No washout | No washout | Short half-life, lower efficacy, extensive safety data with no fetotoxicity; may be used up to conception |
| Glatiramer acetate (brand or any generic formulations) | No washout | No washout | Short half-life, lower efficacy, extensive safety data with no fetotoxicity; may be used up to conception and throughout pregnancy |
| Oral therapies | |||
| Teriflunomide | Plasma levels must be <0.02 mg/L, accelerated elimination can be achieved with cholestyramine | Accelerated elimination protocol; no washout when used and plasma concentration <0.02 mg/L confirmed | Very long half-life, intermediate efficacy, animal evidence of fetotoxicity, not compatible with pregnancy |
| Sphingosine-1-phosphate (S1P) receptor modulators (fingolimod, ozanimod, ponesimod, siponimod) | 2 months for fingolimod 10 days for siponimod 3 months for ozanimod 1 week for ponesimod | 2 months for fingolimod | High efficacy, long half-life, human evidence of fetotoxicity; rebound multiple sclerosis activity after stopping this disease-modifying therapy |
| Cladribine | 6 months | 4 months | High efficacy, intermediate half-life, prolonged biologic activity after administration, no human evidence of fetotoxicity |
| Dimethyl fumarate (brand and generics) | No washout | No washout | Very short half-life, intermediate efficacy, no human evidence of fetotoxicity |
| Monoclonal antibodies | |||
| Alemtuzumab | 4 months | 4 months | Infusion, high efficacy, intermediate half-life but very prolonged biologic activity after administration |
| B-cell-depleting agents (ocrelizumab, rituximab, and ofatumumab) | 6 months | 2 months | Infusion and self-injectable; high efficacy, intermediate half-life but prolonged biologic activity after administration; emerging safety data with pregnancy exposures reassuring |
| Natalizumab | 3 months | No washout | Infusion, high efficacy, intermediate half-life; reassuring emerging safety data with pregnancy exposures; rebound multiple sclerosis activity after stopping this disease-modifying therapy |
