To Örebro University

Introduction: The most appropriate use, type, and timing of contraception in people with multiple sclerosis (PwMS) is poorly understood, and specific guidance is absent.

Aims  and  Objectives: To  provide  insight  into  potential  clinical  guidelines for the use of contraception by PwMS through development  of  recommendations  by a  consensus-based  program  led  by international clinical experts.

Methods:  A  multidisciplinary  steering  committee  (SC)  of  13  international expert healthcare professionals (HCPs) identified 15 key clinical questions on the use of contraception in PwMS, which addressed issues relating to patient-centred care, selection of contraception for PwMS, and time needed to use contraception since the last dose of disease modifying therapies (DMTs). Twenty-five clinical recommendations  addressing  the  questions  were  drafted  using evidence obtained from a comprehensive systematic literature  review  combined  with expert  opinion  from  the  SC.  An  extended faculty of 32 HCPs from 18 countries including a patient association representative, and the SC members (n=12), voted on the   recommendations.   Consensus   on   recommendations   was   achieved when  ⩾75%  of  respondents  expressed  an  agreement  score of 7–9, on a 9-point scale.

Results: Overall, consensus was achieved on 24 out of 25 clinical recommendations. In detail, consensus in the range of 90–100% was  achieved on 11  recommendations,  12  recommendations  achieved  80–89%  consensus,  and 1  recommendation  achieved  75–79%  consensus  (n=44).  The  strength  of recommendations  ranged from 7–9. The one statement failing to achieve consensus scored 74.1%. Clinical recommendations are provided on the process of prescribing contraception for PwMS, including the recommended types of HCPs involved and optimal topics to discuss; the range of contraceptive options and the key considerations involved in selecting an appropriate method of contraception; and the timing of starting and stopping contraception in relation to the use of DMTs.

Conclusions: These  expert  recommendations  were  based  on  a  robust consensus approach, providing timely and practical guidance on the use of contraception for HCPs treating PwMS and will form the basis of further publications and clinical tools.