@Newdave 

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Newdave

Change from Gilenya to Lemtrada or Maven

My sister has highly active MS which was well-controlled with Gilenya (2yrs). She is 28 yrs old now so her neuro mentioned if she'd like to be a pregnant in the future Gilenya is not an option for her and recommends Lemtrada cause it's an induction therapy. After this discussion my sister decided to switch to Lemtrada. Her neuro told she needs a washout time, when her lymphocytes count reach the lower range of normal level (4-8 wks). I read this strategy might be risky cause after washout of Gilenya 10% of patients has a severe rebound. I do not know what is the good strategy. I think it is a simple Russian roulette...
@Stumbler

@newdave , it's a difficult decision for any young lady with MS. Do you stay with a treatment that is conserving your health or give in to the maternal callings of your body clock? There are lots of ifs and buts involved in this decision. MS is so unpredictable that anything could happen at anytime, whether you're taking a Disease Modifying Therapy (DMT) or not. Washout periods are always risky, but you should never give up on your life's aspirations because of this risk. Hopefully, the enhanced "joie de vivre" will carry your sister through.

@ScienceGeek

Your sister should ask her neurologist what non-lympocyte depleting drug she can use to cover the wash-out period. She should be given options like the interferons, galtriamer acetate and maybe terifluonimide (Aubagio). At the very least, the wash-out can be covered by steroids. Doing a drug-free washout period is quite a high risk strategy, and not necessary.