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I had an MRI today and my neurologist called me to tell me I have active lesions and he recommends going on medication. He is only comfortable with Copaxone while I'm breastfeeding. I'm currently nursing my 3 year old and my 4 month old with no plans on stopping any time soon. My newborn was born early, at 32 w 5 d and still nurses frequently. His last weight was 6 lbs 10 oz. In reading this board it looks like Rebif is recommended over Copaxone. I hate shots but will do what I have to for my kids. Is Rebif my best choice and what can I show my neurologist? I've mentioned Dr. Hale many times but he doesn't listen.
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Hi, thanks for your post.
The short answer is that the difference in breastfeeding safety between these two drugs is not large enough to justify picking one over the other based on that property alone. You and your doctor should go with what is most effective in treating your disease. Your improved health and the benefits of breastfeeding likely outweigh the risks of either of these medications.
Rebif is a synthetic interferon and a very effective treatment for MS. Copaxone (glatiramer) is really only indicated for people that do not respond to interferons. It's true that we rate Rebif as safer than Copaxone but that's mostly because we have lots of quality studies on Rebif and almost nothing on Copaxone. Copaxone is a small protein and we do not expect it to get into the milk very much and what does should be quickly destroyed in the infant's stomach. We tried to do a study ourselves to verify this hypothesis, but found that it is impossible to detect this drug in bodily fluids. It will have to remain an L3 until someone publishes a large surveillance study of many moms breastfeeding on this drug.
Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519
-James Abbey, MD
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