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Until fingolimod came along, the first US Food and Drug Administration–approved pill for relapsing-remitting multiple sclerosis (RRMS), teratogenicity of multiple sclerosis (MS) drugs had not been a big issue. Strange, for a disease that affects primarily women of childbearing age. Why? Because previously approved MS drugs were all large recombinant protein molecules. Large molecules cross the placenta by active transport, an issue for natalizumab (a monoclonal antibody), but only after the first trimester, during which the critical periods for organogenesis have been completed. The most commonly used self-injectables (β-interferons and glatiramer acetate) are barely detectable in the circulation and have no known active transport mechanisms. Then came fingolimod, a pill that requires that women who want children take an oral contraceptive or use an otherwise reliable form of contraception.
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- © 2014 American Academy of Neurology
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Letters: Rapid online correspondence
- Response to Drs. Henson and Cavalier
- The pill times 2: What every woman with multiple sclerosis should know
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