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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Factors that determine compatibility of multiple sclerosis disease-modifying therapies with breastfeeding and summary recommendation[1]

Factors that determine compatibility of multiple sclerosis disease-modifying therapies with breastfeeding and summary recommendation[1]
Disease-modifying therapy Description Detectable in breast milk? Transluminal transfer?* Possible effects with infant exposure Compatible with lactation?
Large molecules
Glatiramer acetate Large molecule (4.7 to 13 kDa) heterogeneous strings of amino acids Not done, unlikely Yes, as with any amino acid None Yes
Interferon beta Large molecule, protein 0.0006% relative infant dose Exceedingly low Flulike symptoms Yes
Monoclonal antibodies
Natalizumab IgG4; 149 kDa <1:200 of maternal serum level; 2 to 5% relative infant dose Low InfectionsΔ, impaired vaccine responses or disseminated disease from live vaccinesΔ, hepatitisΔ, anemiaΔ Probably
Rituximab IgG1; 145 kDa Approximately 1:240 of maternal serum level; <1% relative infant dose Low B-cell depletion, infectionsΔ, impaired vaccine responses or disseminated disease from live vaccinesΔ Probably
Ocrelizumab IgG1; 145 kDa Humans not done; monkeys yes Low InfectionsΔ, impaired vaccine responses or disseminated disease from live vaccinesΔ, hepatitisΔ, anemiaΔ Probably
Ofatumumab IgG1; 146 kDa Humans not done; animals not reported Low InfectionsΔ, impaired vaccine responses or disseminated disease from live vaccinesΔ, hepatitisΔ, anemiaΔ Probably
Small molecules
Dimethyl fumarate Immediately metabolized to monomethyl fumarate (129 Da), low protein binding Animals yes/humans not done but highly likely in high amounts High Neurocognitive impairment, lymphopenia, gastrointestinal upset, infectionsΔ, vaccine responsesΔ No
Sphingosine-1-phosphate (S1P) receptor modulators (fingolimod, ozanimod, ponesimod, siponimod) Highly protein bound, long half-life Animals yes/humans not done but highly likely in low amounts Moderate InfectionsΔ, vaccine responsesΔ, cardiovascular effectsΔ, pulmonary toxicityΔ, hepatitisΔ No
Teriflunomide Inhibits pyrimidine synthesis, highly protein bound, very long half-life Animals yes/humans not done but highly likely High Pancytopenia, infections, vaccine responsesΔ, hepatotoxicity, later-life neoplasmsΔ No
Cladribine Inhibits nucleoside metabolism, low protein binding, short half-life Humans not done High LymphopeniaΔ, infectionsΔ, liver injuryΔ, later-life neoplasmsΔ No

IgG: immunoglobulin G; kDa: kilodalton.

* Likelihood of transfer of disease-modifying therapy from infant's gut into its circulation assuming a large amount of disease-modifying therapy is present in breast milk.

¶ Assumes large amounts of the disease-modifying therapy have entered the infant's circulation.

Δ Plausible but unknown risk.
Reference:
  1. Updated and modified with permission from Langer-Gould AM. Pregnancy and family planning in multiple sclerosis. Continuum (Minneap Minn) 2019; 25:773.

From: Bove RM, Houtchens MK. Pregnancy management in multiple sclerosis and other demyelinating diseases. Continuum (Minneap Minn) 2022; 28:12. DOI: 10.1212/CON.0000000000001108. Copyright © 2022 American Academy of Neurology. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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