Is Pregnancy Protective from Rebound After Fingolimod Cessation?

Multiple sclerosis (MS) is a demyelinating neuroimmunological disease that poses significant reproductive challenges for affected women during pregnancy, particularly in relation to disease-modifying therapies (DMTs). Clinical evidence suggests that while pregnancy may exert a protective effect against relapses, severe rebound disease activity can occur following the discontinuation of certain medications such as fingolimod. This case report describes a pregnant woman, age 46 years, with known MS who experienced a rebound phenomenon after abruptly stopping her DMT. She was managed acutely with intravenous methylprednisolone and rituximab. Following high-potency treatment, the patient demonstrated clinical improvement and maintained a stable postpartum course. This case highlights the complexities of managing MS during pregnancy and underscores the need for individualized therapeutic strategies, structured preconception counseling, and careful planning of DMT discontinuation to prevent severe rebound and optimize both maternal and fetal outcomes.