Women with neuromyelitis optica spectrum disorder (NMOSD) showed a pattern of decreased relapses during pregnancy; in addition, the relapse of relapses during the preliminary postpartum period was higher than during pregnancy in patients with aquaporin-4 (AQP4) antibodies (Ab). These results of a retrospective, multicenter, international study were published in Neurology.
The study researchers examined patients (N = 58) who had NMOSD and had at least 1 pregnancy (n = 89) who were treated in 7 hospitals in France, Portugal, or the United Kingdom who were tested for AQP4-Ab and myelin oligodendrocyte glycoprotein (MOG) examines Ab positivity.
The women were AQP4-Ab-positive (51.5%), MOG-Ab-positive (34%) or double negative (14.5%). The onset of NMOSD occurred in the mean age of 27 years (standard deviation [SD], ± 7.0) years and the birth took place at the mean age of 30 (SD, ± 4.9) years. Patients who were AQP4-Ab positive tended to have more coexisting autoimmune diseases (43%) than MOG-Ab positive (30%) or double negative (10%) women (P = .18) and were statistically at higher risk for Miscarriages (20% versus 3% and 0%; P = .05).
Continue reading
The most common relapses observed were unilateral optic neuritis (46%) and myelitis (32%). The patient groups differed with regard to the type of relapse, with AQP4-Ab-positive patients with myelitis or optic neuritis (47% and 44 %%; P = .05) and MOG-Ab-positive patients with optic neuritis (70%). AQP4-Ab (97%) or MOG-Ab (89%) positive patients had more frequent monofocal recurrences. In contrast, double negative patients presented more frequently with monofocal (56%) or bifocal recurrences (33%).
Stratified by time period, relapses were more likely to occur in postpartum trimester 1 in patients with AQP4-Ab positive (P <0.01) and in postpartum trimester 2 in double negative patients. Significant relapse reductions were observed in all women during pregnancy compared to before conception (P <0.01).
Stratified according to pregnancies with or without the use of immunosuppressive therapy, more of the AQP4-Ab-positive cohort used drugs (13 vs. 7) than either MOG-Ab-positive (1 vs. 8) or double-negative (3 vs. 4) groups (P = P .02). The annualized recurrence rate (ARR) was increased in patients without medication (0.33; standard deviation [SD], 0.58) than on (0.19; SD, 0.47; P = 0.04). In patients who were AQP4-Ab positive, the ARR in patients without medication (0.62; SD 0.74) compared to patients with medication (0.24; SD 0.51; P = 0.02) elevated.
This study was limited by its small sample sizes, especially in the subgroups.
Patients with NMOSD had an increased risk of relapse in the first few months after birth. The risk of relapse was reduced in patients who received immunosuppressive therapy during or before pregnancy, especially in the AQP4-Ab positive.
Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.
reference
Colleagues N, Do Rego CA, Bourre B, et al. Pregnancy in patients with AQP4-Ab, MOG-Ab, or double-negative neuromyelitis optica disorder. Neurology. 2021; 96 (15): e2006-e2015. doi: 10.1212 / WNL.0000000000011744
