Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era
Affiliations
Affiliations
- From the Division of Neurology (R.A.), Department of Medicine, Amiri Hospital, Sharq; Department of Pharmacy Practice (M.S.A.), School of Pharmacy, Kuwait University, Jabriya; Department of Neurology (S.F.A., J.A.-H.), Ibn Sina Hospital, Sabah Medical Area, Kuwait; Department of Neurology and Psychiatry (S.F.A.), Minia University, Egypt; Department of Ophthalmology (R.B.), Al-Bahar Eye Center, Sabah Medical Area; and Department of Medicine (J.A.-H.), Faculty of Medicine, Kuwait University, Jabriya. alroughani@gmail.com.
- From the Division of Neurology (R.A.), Department of Medicine, Amiri Hospital, Sharq; Department of Pharmacy Practice (M.S.A.), School of Pharmacy, Kuwait University, Jabriya; Department of Neurology (S.F.A., J.A.-H.), Ibn Sina Hospital, Sabah Medical Area, Kuwait; Department of Neurology and Psychiatry (S.F.A.), Minia University, Egypt; Department of Ophthalmology (R.B.), Al-Bahar Eye Center, Sabah Medical Area; and Department of Medicine (J.A.-H.), Faculty of Medicine, Kuwait University, Jabriya.
Abstract
Objective: To determine the rate of relapse occurrence during pregnancy and postpartum.
Methods: In a cross-sectional study using the national multiple sclerosis (MS) registry, pregnant women with relapsing MS were identified. Data on demographics, clinical characteristics, and disease-modifying therapies (DMTs), including washout periods, were collected. Timings and durations of relapses were extracted. A multivariate logistic regression was used to assess the relationship between relapses and prior use of different DMTs.
Results: Completed data were available for 99 pregnancies (87 patients). Mean age and mean age at onset were 31.8 ± 5 and 24.4 ± 5.6 years, respectively, while the mean disease duration was 7.4 ± 4.6 years. Most pregnancies (89.9%) occurred in patients who were on DMTs in the year preceding pregnancy with a mean treatment duration of 63.4 ± 29 months. The rates of occurrence of relapses during pregnancy and postpartum were 17.2% and 13.7%, respectively. Most of the relapses occurred during the first (n = 6) and third (n = 7) trimesters. Rate of relapse was highest among patients receiving natalizumab and fingolimod before pregnancy. A longer washout period was significantly associated with relapse occurrence.
Conclusion: The relapse occurrence during pregnancy is higher than the previously published rates. The use of high-efficacy therapies with long washout periods before conception was associated with an increased risk of relapses during pregnancy. Postpartum relapse occurrence was similar to that in previous reports.
Similar articles
Risk of relapses during pregnancy among multiple sclerosis patients.
Alroughani R, Akhtar S, Zeineddine M, El Kouzi Y, El Ayoubi NK, Ahmed SF, Behbehani R, Khoury SJ, Al-Hashel JY, Yamout BI.Mult Scler Relat Disord. 2019 Sep;34:9-13. doi: 10.1016/j.msard.2019.06.007. Epub 2019 Jun 10.PMID: 31202959
Relapses and obstetric outcomes in women with multiple sclerosis planning pregnancy.
Berenguer-Ruiz L, Gimenez-Martinez J, Palazón-Bru A, Sempere AP.J Neurol. 2019 Oct;266(10):2512-2517. doi: 10.1007/s00415-019-09450-6. Epub 2019 Jun 29.PMID: 31256279
Hellwig K, Tokic M, Thiel S, Esters N, Spicher C, Timmesfeld N, Ciplea AI, Gold R, Langer-Gould A.JAMA Netw Open. 2022 Jan 4;5(1):e2144750. doi: 10.1001/jamanetworkopen.2021.44750.PMID: 35072719 Free PMC article.
Hellwig K, Verdun di Cantogno E, Sabidó M.Ther Adv Neurol Disord. 2021 Nov 12;14:17562864211051012. doi: 10.1177/17562864211051012. eCollection 2021.PMID: 34876925 Free PMC article. Review.
Varytė G, Zakarevičienė J, Ramašauskaitė D, Laužikienė D, Arlauskienė A.Medicina (Kaunas). 2020 Jan 21;56(2):49. doi: 10.3390/medicina56020049.PMID: 31973138 Free PMC article. Review.
Cited by
Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges.
Khan Z, Gupta GD, Mehan S.J Clin Med. 2023 Jun 26;12(13):4274. doi: 10.3390/jcm12134274.PMID: 37445309 Free PMC article. Review.
Multiple Sclerosis Disease Activity and Disability Following Cessation of Fingolimod for Pregnancy.
Hellwig K, Tokic M, Thiel S, Hemat S, Timmesfeld N, Ciplea AI, Gold R, Langer-Gould AM.Neurol Neuroimmunol Neuroinflamm. 2023 May 22;10(4):e200126. doi: 10.1212/NXI.0000000000200110. Print 2023 Jul.PMID: 37217309 Free PMC article.
Haker MC, Frahm N, Hecker M, Langhorst SE, Mashhadiakbar P, Debus JL, Streckenbach B, Baldt J, Heidler F, Zettl UK.Ther Adv Drug Saf. 2023 Jan 11;14:20420986221143830. doi: 10.1177/20420986221143830. eCollection 2023.PMID: 37007872 Free PMC article.
Graham EL, Bakkensen JB, Anderson A, Lancki N, Davidson A, Perez Giraldo G, Jungheim ES, Vanderhoff AC, Ostrem B, Mok-Lin E, Huang D, Bevan CJ, Jacobs D, Kaplan TB, Houtchens MK, Bove R.Neurol Neuroimmunol Neuroinflamm. 2023 Mar 15;10(3):e200106. doi: 10.1212/NXI.0000000000200106. Print 2023 May.PMID: 36922025 Free PMC article.