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MS – DMT and Breastfeeding — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – DMT and BreastfeedingSCE Neurology

A 28-year-old woman with RRMS wishes to breastfeed. She has been on glatiramer acetate, which she stopped 2 months before delivery. She is currently 2 weeks post-partum and has had no relapses. What is the current advice regarding DMT resumption and breastfeeding?

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Correct answer: B — Glatiramer acetate is compatible with breastfeeding and can be resumed

Glatiramer acetate is considered compatible with breastfeeding as it is a large polypeptide unlikely to be absorbed orally by the infant and has minimal transfer into breast milk. Current ABN guidance and expert consensus support its use during breastfeeding. Natalizumab may also be continued during breastfeeding in selected cases. A: Some DMTs are compatible with breastfeeding. C: Not all DMTs are safe (e.g., teriflunomide, cladribine are contraindicated). D: 12 months is unnecessarily long; relapse risk is highest in the first 3 months post-partum. E: Fingolimod is contraindicated in breastfeeding.

Reference: ABN MS Guidelines (2022); Montalban et al. ECTRIMS/EAN MS Guidelines (2018)