Natalizumab, Fingolimod and Dimethyl Fumarate Use and Pregnancy-Related Relapse and Disability in Women With Multiple Sclerosis
| Autor: | Raymond Hupperts, Pierre Duquette, Tomas Uher, Wei Zhen Yeh, Karolina Vodehnalova, Suzanne Hodgkinson, Ayse Altintas, Celia Oreja-Guevara, Serkan Ozakbas, Michael Barnett, Tamara Castillo-Triviño, Francois Grand'Maison, Jeannette Lechner-Scott, Daniele Spitaleri, Olga Skibina, Vilija Jokubaitis, Franco Granella, Tomas Kalincik, Elisabetta Cartechini, Pierre Grammond, Melissa Gresle, Richard A L Macdonell, Jim Stankovich, Dana Horakova, Marco Onofrj, Vincent Van Pesch, Sara Eichau, Recai Turkoglu, Roberto Bergamaschi, Albert Saiz, Raed Alroughani, Aysun Soysal, Helmut Butzkueven, Radek Ampapa, Putu Ayu Widyastuti, Cavit Boz, Francesco Patti, Pamela A. McCombe, Patrizia Sola, Murat Terzi, Maria Pia Amato, Anneke van der Walt, Eva Havrdova, Maria José Sá, Bassem Yamout, Davide Maimone |
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| Přispěvatelé: | UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Pregnancy Clinically isolated syndrome Obstetrics business.industry Hazard ratio Odds ratio medicine.disease Fingolimod Article 03 medical and health sciences 0302 clinical medicine Natalizumab Cohort medicine Gestation 030212 general & internal medicine Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Neurology, Vol. 96, no.24, p. e2989-3002 (2021) Neurology |
| Popis: | ObjectiveTo investigate pregnancy-related disease activity in a contemporary multiple sclerosis (MS) cohort.MethodsUsing data from the MSBase Registry, we included pregnancies conceived after December 31, 2010, in women with relapsing-remitting MS or clinically isolated syndrome. Predictors of intrapartum relapse and postpartum relapse and disability progression were determined by clustered logistic regression or Cox regression analyses.ResultsWe included 1,998 pregnancies from 1,619 women with MS. Preconception annualized relapse rate (ARR) was 0.29 (95% confidence interval 0.27–0.32), fell to 0.19 (0.14–0.24) in the third trimester, and increased to 0.59 (0.51–0.67) in early postpartum. Among women who used fingolimod or natalizumab, ARR before pregnancy was 0.37 (0.28–0.49) and 0.29 (0.22–0.37), respectively, and increased during pregnancy. Intrapartum ARR decreased with preconception dimethyl fumarate use. ARR spiked after delivery across all DMT groups. Natalizumab continuation into pregnancy reduced the odds of relapse during pregnancy (odds ratio 0.76 per month [0.60–0.95], p = 0.017). DMT reinitiation with natalizumab protected against postpartum relapse (hazard ratio [HR] 0.11 [0.04–0.32], p < 0.0001). Breastfeeding women were less likely to relapse (HR 0.61 [0.41–0.91], p = 0.016). We found that 5.6% of pregnancies were followed by confirmed disability progression, predicted by higher relapse activity in pregnancy and postpartum.ConclusionIntrapartum and postpartum relapse probabilities increased among women with MS after natalizumab or fingolimod cessation. In women considered to be at high relapse risk, use of natalizumab before pregnancy and continued up to 34 weeks gestation with early reinitiation after delivery is an effective option to minimize relapse risks. Strategies of disease-modifying therapy use have to be balanced against potential fetal/neonatal complications. |
| Databáze: | OpenAIRE |
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