| Study | Country Study period Study design  | 
                Data source | Exposure definition | Non-exposure definition | Exposition period | Sample size (exposed/unexposed) Or (case / control)  | 
                Remarks | Risk of bias | 
|---|---|---|---|---|---|---|---|---|
| 
                    
                    Karlsson (control exposed to IFN) 2014  | 
                
                    Worldwide Until 2011 retrospective cohort  | 
                9 clinical studies in the fingolimod clinical development program. | Fingolimod treatment at the time of conception or within 6 weeks prior to conception. | 
                    exposed to other treatment, sick
                     Interferon beta-1a treatment at the time of conception or within 6 weeks prior to conception.  | 
                1st trimester | 66 / 4 | Malformations: Numeratos: addition of anomalies in newborn and ETOP; Denominators: newborn and fetus with available information. The duration of in utero fingolimod exposure in the majority of live births was estimated to be >8 weeks to <=12 weeks. | |
| Patients received treatment provided by the investigator in clinical trial. | ||||||||
| 
                    
                    Karlsson (control unexposed, sick) 2014  | 
                
                    Worldwide Until 2011 retrospective cohort  | 
                9 clinical studies in the fingolimod clinical development program. | Fingolimod treatment at the time of conception or within 6 weeks prior to conception. | 
                    unexposed, sick
                     Placebo treatment at the time of conception or within 6 weeks prior to conception.  | 
                1st trimester | 66 / 11 | Malformations: Numeratos: addition of anomalies in newborn and ETOP; Denominators: newborn and fetus with available information. The duration of in utero fingolimod exposure in the majority of live births was estimated to be >8 weeks to <=12 weeks. | |
| Patients received treatment provided by the investigator in clinical trial. | ||||||||
| 
                    
                    Nguyen (control exposed to IFN) 2019  | 
                
                    International 2005 - 2016 prospective cohort  | 
                The Multiple Sclerosis (MS) Base Registry is a large, international observational cohort study, with long-term prospectively collected data. | Pregnancies occurring during Fingolimod therapy. (This is a subgroup of exposure among the exposed group considered in the study). | 
                    exposed to other treatment, sick
                     Pregnancies occurring during Interferon beta (all) therapy. (This is a subgroup of exposure among the exposed group considered in the study).  | 
                during pregnancy (anytime or not specified) | 21 / 350 | ||
| Data in the MSBase registry, including prospective pregnancy data, is entered in real time or near real time, as part of routine clinical visits. Information collected included: disease-modifying therapies exposure before and during pregnancy. | ||||||||
| 
                    
                    Nguyen (control unexposed, sick) 2019  | 
                
                    International 2005 - 2016 prospective cohort  | 
                The Multiple Sclerosis (MS) Base Registry is a large, international observational cohort study, with long-term prospectively collected data. | Pregnancies occurring during Fingolimod therapy. (This is a subgroup of exposure among the exposed group considered in the study). | 
                    unexposed, sick
                     Pregnancies not exposed to disease-modifying therapies (DMTs) (pregnancy occurring within a year of DMT discontinuation or without DMT exposure in the prior year).  | 
                during pregnancy (anytime or not specified) | 21 / 886 | ||
| Data in the MSBase registry, including prospective pregnancy data, is entered in real time or near real time, as part of routine clinical visits. Information collected included: disease-modifying therapies exposure before and during pregnancy. | ||||||||
| 
                    
                    Pauliat 2020  | 
                
                    Germany, Switzerland, Israel, France, Spain, Turkey, Australia 2000 - 2017 prospective cohort  | 
                Eight participating Teratology Information Services (TIS) and nine pharmacovigilance centers. | Pregnant women having used fingolimod during the first trimester. | 
                    exposed to other treatment, sick
                     Pregnant women having used IFN-beta during the first trimester.  | 
                1st trimester | 63 / 62 | Fingolimod was discontinued at a median gestational age of 6 weeks (IQR 5-7, min 3, max 19). Exclusion criteria for both groups included exposure during pregnancy to any known major teratogen or fetotoxicant and to any treatment for malignancy. | |
| Maternal information on medication exposure (indication, timing in pregnancy, duration, dose and concomitant medication) were collected at initial contact. | ||||||||
| Study | Country Study period Study design  | 
                Data source | Case | Control | Exposition | Exposition period | Sample size (exposed/unexposed) Or (case / control)  | 
                Remarks | Risk of bias | 
|---|
Risk of bias: : NA; : low; : moderate; : serious; : critical; : unclear;