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

Abstract

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...

Peripartum disease activity in moderately and severely disabled women with multiple sclerosis

“…Further, the structure of our dataset did not allow for assessment of the impact of bridging therapies with monthly steroid infusions or IVIG during breastfeeding, strategies used by many clinicians with some prior evidence of efficacy. 33 – 35 Acknowledging these limitations, there were very few cases, eight, of postpartum relapse after DMT initiation.…”

Pregnancy and Multiple Sclerosis: An Update on the Disease Modifying Treatment Strategy and a Review of Pregnancy’s Impact on Disease Activity

“…There was a study performed evaluating the impact of intravenous methylprednisolone (IVMP) administration after delivery on the prevention of MS reactivation postpartum. As a result, relapses appeared in 17.9% of women treated with IVMP compared to a 46.2% relapse rate in the control group [49].…”

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

“…141 In another American study, among 39 women receiving 1 g methylprednisolone after delivery, 17.9% experienced a relapse in the 3 months PP versus 46.2% of the 13 untreated controls. 142 In a recent multicentric French study, 350 women with MS were included, 116 from MS expert centres proposing systematically monthly CS pulses after delivery and 234 from centres never using CS for preventing PP relapses (Michel L, COPP-MS, submitted). In the first trimester of PP, the ARR and the percentage of patients with relapse were 0.45 versus 0.69 and 11% versus 14% in the treated versus untreated groups (not statistically significant).…”