计划生育对于建立多发性硬化(MS)预后至关重要,治疗决定,和疾病监测。我们旨在达成专家共识,以解决育龄MS患者的计划生育建议。最初,一个由七名神经学家组成的委员会,MS领域的专家,确定了要解决的主题。然后,委员会阐述了不同的基于证据的初步陈述。接下来,使用Delphi方法,一组神经学家使用Likert型量表显示了他们对不同陈述的一致性水平。当70%的受访者使用五点量表表示同意或不同意时,就达成了共识。经过三轮评价,就63项建议中的47项达成了共识。小组认为必须解决所有育龄患者的计划生育问题。也有共识,治疗不应由于患者的怀孕愿望而延迟。此外,在高度活跃的患者中,使用克拉屈滨或阿仑珠单抗等耗竭药物计划中期至长期妊娠可能是一种有用的策略.然而,在考虑阿仑珠单抗时,应解决药物相关的继发性自身免疫对胎儿产生不利影响的风险.此外,非常活跃的患者在妊娠期间维持那他珠单抗已达成专家共识.此外,研究小组支持在选定病例中在泌乳期间使用某些疾病改善治疗(DMT).我们的结果确定了MS患者怀孕计划的具体领域,可能考虑采用不同的治疗策略,以促进安全和成功的妊娠,同时保持临床和放射学的稳定性。
Family planning is essential for establishing Multiple Sclerosis (MS) prognosis, treatment decision, and disease monitoring. We aimed to generate an expert
consensus addressing recommendations for family planning in MS patients of childbearing age. Initially, a committee comprising seven neurologists, experts in the MS field, identified the topics to be addressed. Then, the committee elaborated on different evidence-based preliminary statements. Next, using the Delphi methodology, a panel of neurologists manifested their level of agreement on the different statements using a Likert-type scale.
Consensus was reached when ⩾70% of respondents expressed an agreement or disagreement using a five-point scale.
Consensus was achieved on 47 out of 63 recommendations after three rounds of evaluations. The panel considered it essential to address family planning in all patients of childbearing age. There was also
consensus that treatment should not be delayed due to the patient\'s desire for pregnancy. Additionally, in highly active patients, planning the pregnancy in the medium to long term using depletory drugs such as cladribine or alemtuzumab might represent a useful strategy. However, risks of adverse effects on the fetus due to drug-associated secondary autoimmunity should be addressed when alemtuzumab is considered. Moreover, the maintenance of natalizumab during pregnancy in very active patients reached expert
consensus. Also, the panel supported the use of certain disease-modifying treatment (DMT) during lactation in selected cases. Our results identified specific areas of pregnancy planning in MS patients, where different treatment strategies might be considered to facilitate a safe and successful pregnancy while maintaining clinical and radiological stability.