Intravenous corticosteroids in the postpartum period for reduction of acute                 exacerbations in multiple sclerosis

Seze, J. de; Chapelotte, M; Delalande, S.; Ferriby, D.; Stojkovic, Tanya; Vermersch, Patrick

doi:10.1191/1352458504ms1079sr

Cited by 82 publications

(41 citation statements)

References 4 publications

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“…12 Another study had already shown a beneficial effect of postpartum IV steroids in relapse rate reduction in a small group, but with monthly infusion for 6 months. 13 In our study we found a significant reduction in the percentage of patients having relapses during the first postpartum trimester in those who received postpartum IV steroids compared with those who did not receive them. The difference between the two groups in the percentage of patients having relapses was not significant during the second and third postpartum trimesters.…”

Section: Resultssupporting

confidence: 55%

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

Avila-Ornelas

Avila

Stosic

et al. 2011

International Journal of MS Care

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Multiple sclerosis (MS) is most prevalent in women of childbearing age. It is well established that the relapse rate decreases during pregnancy but increases significantly during the first postpartum trimester. The objective of this retrospective study was to evaluate the effectiveness of the administration of 1 g of intravenous methylprednisolone (IVMP) after delivery in the prevention of MS relapses. The study involved 47 women with one or more documented pregnancies; each pregnancy was treated as a separate case. There were 50 cases with relapsing-remitting MS and 2 with secondary progressive MS. The cases were divided into two groups: the IVMP group (those who received 1 g of IVMP after delivery) and the no-IVMP group (those who did not receive IVMP after delivery). There were 39 cases in the IVMP group and 13 in the no-IVMP group. During the first postpartum trimester, relapses occurred in 17.9% of the IVMP group, compared with 46.2% of the no-IVMP group (P = .0448). The difference in relapse percentage between the two groups during the second and third postpartum trimesters was not statistically significant. Our study shows a statistically significant benefit of postpartum IVMP administration in reducing MS relapses. Int J MS Care. 2011;13:91-93. Multiple sclerosis (MS) is most prevalent among women of childbearing age. 1 Recent studies have shown that pregnant MS patients have the same risk of pregnancy complications as the general population. 2 The influence of pregnancy on the course of disease in MS has also been studied over the years.According to the Pregnancy in Multiple Sclerosis (PRIMS) trial, the mean ± SD number of relapses was 0.7 ± 0.9 per woman per year in the year before pregnancy; it was 0.5 ± 1.3 during the first trimester of pregnancy, 0.6 ± 1.6 during the second trimester, and 0.2 ± 1.0 during the third trimester. It increased to 1.2 ± 2.0 during the first 3 months postpartum and then returned to the pre-pregnancy rate. 3 After a 2-year follow-up analysis, the researchers described clinical factors that might predict the likelihood of relapse in the 3 months after delivery: an increased relapse rate in the pre-pregnancy year, an increased relapse rate during pregnancy, and a higher Expanded Disability Status Scale (EDSS) score at pregnancy onset. 4 The reason for the increased postpartum activity is not yet clear, but many factors have been considered, including the decrease in estrogen levels and the reduced activity of some immune-inhibitory molecules. 5 Previous studies suggested a reduction in the postpartum relapse rate for MS patients after exclusive breastfeeding, 6,7 but this tendency was not shown in a more recent study. 8 Breastfeeding was also not shown to affect postpartum relapse activity in PRIMS. 4 Data published by Oliveri et al. 9 showed that intravenous methylprednisolone (IVMP) reduced magnetic resonance imaging (MRI) activity, defined as the number of contrast-enhancing lesions over a 2-month period. Therefore, we hypothesized that a dose of IVMP in the immediate pos...

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Section: Resultssupporting

confidence: 55%

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

Avila-Ornelas

Avila

Stosic

et al. 2011

International Journal of MS Care

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“…As noted earlier, ideally this issue is dealt with before pregnancy occurs. Small-scale studies have evaluated postpartum prophylactic intravenous immune globulin, as well as pulse corticosteroids, to minimize relapses with reported success [De Seze et al 2004;Haas and Hommes, 2007]. Hormonal therapy (percutaneous 17-β estradiol 100 µg weekly along with oral nomegestrol acetate 10 mg daily) was evaluated in the POPARTMUS trial, but showed no ability to suppress postpartum relapses or MRI activity [Durand-Dubief et al 2014].…”

Section: Disease Activitymentioning

confidence: 99%

Management of women with multiple sclerosis through pregnancy and after childbirth

Coyle

2016

Ther Adv Neurol Disord

121

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Multiple sclerosis (MS) is a major acquired neurologic disease of young adults. The prototypic patient is a young woman of reproductive age. Gender preference is becoming more pronounced, since MS is increasing specifically among women. Any healthcare provider who deals with MS must be prepared to discuss pregnancy issues, and provide appropriate counseling. This is now complicated by the availability of multiple treatment options. There is growing literature on which to base recommendations, particularly regarding washout periods. After a brief background introduction, this review will discuss state-of-the-art family planning counseling in the treatment era, divided into prepregnancy, pregnancy, and postpartum MS issues.

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“…Little is known about potent postpartal relapse prevention. Prophylactic application of intravenous steroids showed some effect in a small cohort [de Seze et al 2004], but this may interact with wound healing after delivery. A contraindication exists for the current available disease-modifying therapies (DMTs; i.e., interferon (IFN) beta or glatiramer acetate) during pregnancy and breast-feeding [Hoffmann et al 2006;Coyle et al 2004].…”

Section: Introductionmentioning

confidence: 99%

Immunomodulation and postpartum relapses in patients with multiple sclerosis

Hellwig

Beste

Schimrigk³

et al. 2009

Ther Adv Neurol Disord

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Multiple sclerosis (MS) mainly affects young women during a life period with desire for children. Relapse rate decreases during pregnancy and rises after delivery. Therefore, studies on satisfactory postpartum relapse prevention and its efficacy are essential. Previous smaller and uncontrolled studies suggested that intravenous immunoglobulin (IVIG) administration reduced the relapse rate following delivery. The objective of our observational study was to compare the efficacy of IVIG application, treatment with other immunomodulatory compounds or no treatment at all on the postpartal relapse rate in female MS patients from our pregnancy database. One hundred and twenty four pregnancies were followed in a partly prospective design. Relapse rate was reduced during pregnancy (p50.001) and increased during the initial 3 months after delivery in all MS patients (p50.001). The relapse rate reduction showed only a trend in favour of the IVIG-treated women, probably due to the small number of patients. However, analysing the expected number of relapses, IVIG treated patients had significantly less relapses postpartum than the untreated control group matched for disease activity before and during pregnancy ( 2 , p ¼ 0.013). The results suggest that IVIG could be an option to prevent postpartum relapse of MS.

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Intravenous corticosteroids in the postpartum period for reduction of acute exacerbations in multiple sclerosis

Cited by 82 publications

References 4 publications

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

The Role of Postpartum Intravenous Corticosteroids in the Prevention of Relapses in Multiple Sclerosis

Management of women with multiple sclerosis through pregnancy and after childbirth

Immunomodulation and postpartum relapses in patients with multiple sclerosis

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