Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs

Amato, Maria Pia; Portaccio, Emilio; Hakiki, Bahia; Sturchio, Andrea; Pastò, Luisa; Giannini, Marta; Razzolini, Lorenzo; Piscolla, E.; Siracusa, G.; Ghezzi, Angelo; Rizzo, Aroldo; Zaffaroni, Mauro; Martinelli, Vittorio; Radaelli, Marta; Moiola, Lucia; Comı, Gıancarlo; Protti, Alessandra; Spreafico, C; Marazzi, Raffaella; Cavalla, Paola; Masera, Silvia; Bergamaschi, Roberto; Mancardi, Gian Luigi; Capello, Elisabetta; Solaro, Claudio; Tola, Maria Rosaria; Caniatti, Luisa; Granella, Franco; Immovilli, Paolo; Annunziata, Pasquale; Santi, Lorenzo De; Plewnia, Katrin; Guidi, Leonello; Bartolozzi, Maria Letizia; Mazzoni, Monica; Pozzilli, Carlo; Giglio, Laura De; Totaro, Rocco; Carolei, Antonio; Rossi, Maria Elisabetta; Lugaresi, Alessandra; Luca, Giovanna De; Tommaso, V. Di; Trojano, María; Paolicelli, Damiano; Carrozzo, Alessandro; D’Onghia, Mariangela; Marrosu, Maria Giovanna; Musu, Luigina; Patti, Francesco; Carmela, L.; Fermo, Salvatore Lo

doi:10.1136/jnnp-2013-306054

Cited by 70 publications

(99 citation statements)

References 28 publications

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“…Most of the studies have not shown any negative effect of a pregnancy on long-term disease course/progression or disability [32]; some even reported favorable effects [12,29,31]. We showed that MS patients who had only 1 pregnancy had a higher conversion rate from RRMS to SPMS than MS patients with 2 or more pregnancies (p = 0.001).…”

Section: Discussionsupporting

confidence: 53%

“…To our knowledge, the data that specifically aimed at answering this matter have also been lacking in the literature [31]. In addition, a recent study has shown that caesarean section or epidural anaesthesia has not been associated with any adverse effect on delivery or postpartum MS course [29]. …”

Section: Discussionmentioning

confidence: 99%

“…The interaction between fetal antigens and maternal immune system, the abrupt decrease in estrogen levels following delivery and the loss of immunotolerant state of pregnancy are defined as possible factors [7,25,27,28]. In a recent study from Italy, it was reported that the early introduction or resumption of DMDs within the first 3 months after delivery reduced the risk of post-partum relapses [29]. …”

Section: Discussionmentioning

confidence: 99%

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Pregnancy Data in a Turkish Multiple Sclerosis Population

et al. 2015

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Background: To conduct the first retrospective clinical study investigating pregnancy in Turkish multiple sclerosis (MS) patients. Summary: We evaluated 558 pregnancies in 199 MS patients and results were compared with general Turkish population's data. The fertility rate in the MS group was found to be lower than that in the general population, even before MS diagnosis was established. Our study suggests that the higher number of pregnancies may have a favorable effect on transition from relapsing-remitting MS to secondary progressive MS, although no effect has been shown regarding the possibility to reach EDSS 6.0 as a milestone. Key Messages: Our data support the conclusion that MS does not have a negative effect on the MS course and disability.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pregnancy Data in a Turkish Multiple Sclerosis Population

et al. 2015

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“…These patterns could be explained by the immunological effects of changes in circulating pregnancy hormones (oestrogen, progesterone, prolactin and others) [79] and by changes in the expression of inflammation-related genes [80]. The occurrence of postpartum relapses was more frequent in women with a higher EDSS score at conception and a higher relapse rate before and during pregnancy [77,81,82]. However, the majority of the studies were conducted before the introduction of DMDs; thus, fewer data on the possible impact of pregnancy on the MS course in the scenario of DMD treatment are available.…”

Section: Fertility Pregnancy Foetal Development Delivery and Breasmentioning

confidence: 94%

Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs

Amato

Portaccio

2015

CNS Drugs

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In recent decades, pregnancy-related issues in multiple sclerosis (MS) have received growing interest. MS is more frequent in women than in men and typically starts during child-bearing age. An increasing number of disease-modifying drugs (DMDs) for the treatment of MS are becoming available. Gathering information on their influences on pregnancy-related issues is of crucial importance for the counselling of MS patients. As for the immunomodulatory drugs (interferons and glatiramer acetate), accumulating evidence points to the relative safety of pregnancy exposure in terms of maternal and foetal outcomes. In case of higher clinical disease activity before pregnancy, these drugs could be continued until conception. As for the 'newer' drugs (fingolimod, natalizumab, teriflunomide, dimethyl fumarate and alemtuzumab), the information is more limited. Whereas fingolimod and teriflunomide are likely associated with an increased risk of foetal malformations, the effects of natalizumab, dimethyl fumarate and alemtuzumab still need to be ascertained. This article provides a review of the available information on the use of DMDs during pregnancy, with a specific focus on fertility, foetal development, delivery and breast-feeding.

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“…9 This pattern is maintained in women treated with interferon-beta or glatiramer acetate who stop these therapies before conception. [10][11][12] However, in women who stop more effective therapies such as fingolimod or natalizumab before conception, the annualized relapse rate increases during pregnancy and post-partum. [12][13][14] While it is uncertain whether these differences in relapse rate reflect inherent differences in the disease activity of women using different DMT, or rebound effects of stopping highly effective agents in the specific setting of pregnancy, these differences in outcomes are clinically relevant.…”

mentioning

confidence: 99%