TABLE 1

Special considerations for use of disease-modifying therapies in pregnancy^{^a,^b}

Medication	Recommended washout period	Use in pregnancy
Interferons Interferon beta-1a^14,15 Peginterferon beta-1a¹⁶ Interferon beta-1b^13,17	2 weeks	Use only if benefit outweighs risks
Glatiramer acetate^18,19	None	Use only if benefit outweighs risks
Fumarates Dimethyl fumarate²⁸ Diroximel fumarate²⁹ Monomethyl fumarate³⁰	1 week	Not advised
Sphingosine 1-phosphate receptor modulators Fingolimod³² Siponimod³³ Ozanimod³⁴ Ponesimod³⁵	Fingolimod: 2–3 months Siponimod: 2 weeks Ozanimod: 3 months Ponesimod: 1 week	Spingosine 1-phosphate receptor modulators are not advised Risk for rebound disease activity Consider transition to a B-cell-depleting agent before discontinuing contraception
Cladribine¹⁰	6 months	Not advised
Teriflunomide³¹	Rapid-elimination procedure required: cholestyramine 8 g every 8 hours orally for 11 days (if not tolerated, reduce dose to 4 g every 8 hours) or activated charcoal powder 50 g every 12 hours for 11 days until a serum concentration below 0.02 mg/L is reached	Not advised; stop treatment and eliminate drug before discontinuing contraception
Natalizumab²¹	2–3 months	Generally not advised Use in special circumstances; high risk for rebound disease activity Consider transition to a B-cell-depleting agent before discontinuing contraception
B-cell–depleting agents Ocrelizumab²² Ofatumumab²³ Rituximab^24,25 Ublituximab²⁶	1–3 months^{^c}	B-cell–depleting agents are generally not advised; package inserts recommend washout periods of 6 months for ocrelizumab, 6 months for ofatumumab, 6 months for ublituximab, and 12 months for rituximab^c
Alemtuzumab²⁷	4 months	Use not advised

↵a This table reflects our clinical practice and review of combined recommendations of prescribing information and key articles.
↵b Pregnancy testing is recommended before starting or re-dosing for all disease-modifying therapy in women of childbearing potential.
↵c See Question 7 in the article for an in-depth discussion of B-cell-depleting therapies and pregnancy timing.
Based on information in references 1,5,10,11, and 13–41.