Pregunta 47. Cuál es el consejo correcto en esta paciente con MS Que quiere embarazo?

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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 47 OF 100

47.
A 33-year-old woman with a history of multiple sclerosis has been stable on teriflunomide, with no relapses for the past 3 years. She states she wants to start a family and wants to know the potential risks associated with pregnancy. Which of the following is the most appropriate course of action?

A. Advise the patient to avoid getting pregnant.
B. Change the disease-modifying agent to fingolimod and advise her to proceed.
C. Initiate elimination with cholestyramine before proceeding
D. Continue the current treatment plan with no changes.
E. Discontinue teriflunomide today and advise her to proceed. **
** = Your answer
Teriflunomide is contraindicated in pregnancy because embryotoxicity and teratogenicity have been demonstrated in animal studies when the drug is administered at recommended human doses. If a patient on teriflunomide wishes to become pregnant, or becomes pregnant accidentally, elimination with cholestyramine is required. Teriflunomide has no known effect on male fertility, although animal studies have demonstrated a reduction in sperm count. Fingolimod does not appear to reduce fertility. Animal studies of fingolimod demonstrate teratogenicity and embryolethality at doses lower than the therapeutic human dose. The most common malformations are persistent truncus arteriosus and ventricular septal defect.
References
* Fabian M. Pregnancy in the setting of multiple sclerosis. Continuum Lifelong Learning Neurol. 2016;22(3):837-850.
* Kieseier BC, Benamor M. Pregnancy outcomes following maternal and paternal exposure to teriflunomide during treatment for relapsing-remitting multiple sclerosis. Neurol Ther. 2014 Nov 20;3(2):133-138.

 

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