Neurological

Disease-modifying drug use during pregnancy combined with fewer postpartum relapses in MS

Women with relapsing multiple sclerosis (MS) who were exposed to disease-modifying drugs (DMDs) in early pregnancy have fewer postpartum relapses, according to study results presented at the Consortium of Multiple Sclerosis Centers Annual Meeting 2021.

MS relapses tend to decrease during pregnancy, but previous research suggests that there is an increased risk of relapse in the first few months after giving birth. The aim of the current study was to determine whether the use of DMDs could influence the risk of postpartum relapse in women with MS.

In a systematic review, researchers searched the Embase and MEDLINE databases for relevant studies published between November 2009 and 2019. A total of 17 studies reporting data on postpartum relapse were included.

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The studies included a total of 2522 patients and 2803 pregnancies – 1611 pregnancies were exposed to DMDs during preconception, 451 during pregnancy and 540 after birth. Postpartum relapses were mainly reported as the relapse rate (RR; n = 6 [range 0.1-0.6]) and annualized RR (n = 5 [range 0.2-1.1]).

Exposure to DMDs in early pregnancy was associated with fewer postpartum relapses (DMD: platform therapy, n = 2; intravenous [IV] Infusion, n = 1) vs. no DMD exposure in 3 of 4 studies. The other study found no difference between the groups (relapsed patients exposed to DMDs, 23%; not exposed, 27%).

The preconception of DMD exposure generally had no effect on postpartum recurrences (DMD: various, n = 3) compared to no DMD exposure, although one study found that preconception did involve highly effective DMD use (iv or oral) was associated with postpartum recurrences (rate ratio 2.11; 95% CI 1.32-3.27) vs. no highly effective DMD application.

Some studies showed that resumption of DMDs during early postpartum decreased the number of relapses compared to delayed resumption (DMD: various, n = 3; IV infusion, n = 2). Other studies found no significant influence on the risk of relapse (DMD: various, n = 3).

“Findings on postpartum relapse in women with MS who were exposed to DMDs varied,” the researchers said. “In terms of clinical disease activity, decision-making regarding the benefit-risk of DMD use before, during and after pregnancy remains difficult.”

Disclosure: Some of the study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of the author’s disclosures, see the original reference.

reference

Hellwig K, Verdun di Cantogno E, Sabidó M. Postpartum recurrence rates in women with relapsing multiple sclerosis and the effects of disease-modifying drugs: a systematic review. Presented at: CMSC Annual Meeting 2021; 25.-28. October 2021; Orlando Florida. Summary DMT02.

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