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Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era.
Neurology. 2018 03 06; 90(10):e840-e846.Neur

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.

Authors+Show 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.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.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.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.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29429970

Citation

Alroughani, Raed, et al. "Relapse Occurrence in Women With Multiple Sclerosis During Pregnancy in the New Treatment Era." Neurology, vol. 90, no. 10, 2018, pp. e840-e846.
Alroughani R, Alowayesh MS, Ahmed SF, et al. Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era. Neurology. 2018;90(10):e840-e846.
Alroughani, R., Alowayesh, M. S., Ahmed, S. F., Behbehani, R., & Al-Hashel, J. (2018). Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era. Neurology, 90(10), e840-e846. https://doi.org/10.1212/WNL.0000000000005065
Alroughani R, et al. Relapse Occurrence in Women With Multiple Sclerosis During Pregnancy in the New Treatment Era. Neurology. 2018 03 6;90(10):e840-e846. PubMed PMID: 29429970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era. AU - Alroughani,Raed, AU - Alowayesh,Maryam S, AU - Ahmed,Samar F, AU - Behbehani,Raed, AU - Al-Hashel,Jasem, Y1 - 2018/02/02/ PY - 2017/07/21/received PY - 2017/12/04/accepted PY - 2018/2/13/pubmed PY - 2019/7/25/medline PY - 2018/2/13/entrez SP - e840 EP - e846 JF - Neurology JO - Neurology VL - 90 IS - 10 N2 - 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. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/29429970/Relapse_occurrence_in_women_with_multiple_sclerosis_during_pregnancy_in_the_new_treatment_era_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=29429970 DB - PRIME DP - Unbound Medicine ER -