Immunosuppressive Therapy Prior to Pregnancy Not Associated With Negative Long-Term Outcomes in NMOSD

STOCKHOLM — The use of immunosuppressive therapy (IST) prior to pregnancy in women with neuromyelitis optica spectrum disorder (NMOSD) is not associated with negative long-term outcomes, according to study results presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held September 11-13, 2019 in Stockholm, Sweden.

The study analyzed a total of 128 women with NMOSD (age of disease onset, <46 years). Patients who became pregnant after the onset of NMOSD were compared with patients who were either never pregnant or only pregnant prior to the onset of disease. Groups were compared with regard to the long-term effect of pregnancy on disease outcome.

A total of 17 women reached an Expanded Disability Status Scale score of 6.0 after a median disease duration of 12 years, and 28 women had 35 pregnancies following the onset of NMOSD (median age at NMOSD onset, 26 years). The majority of pregnancies ended in live births (74%), 17% in miscarriages, and 9% in elective abortions.

The researchers identified 14 pregnancies in women prior to initiating IST. There were 21 pregnancies after a median of 57 months of IST initiation (azathioprine [n=3], mycophenolate mofetil [n=2], mitoxantrone followed by mycophenolate mofetil [n=1], and rituximab [n=15]). In approximately 50% of the pre-IST pregnancies there was an acute attack during or after pregnancy, while this occurred in only 24% of post-IST pregnancies.

Limitations of the study included the retrospective nature of the analysis, as well as the small number of women in the final dataset.

“Stabilizing disease activity through long-term IST before pregnancy should be recommended in women with NMOSD,” study presenter, Su-Hyun Kim, MD, told Neurology Advisor. “However, discontinuation of oral immunosuppressive agents appeared to increase the risk of pregnancy-related attacks even after several relapse-free years on treatment. Rituximab treatment prior to pregnancy might help to prevent pregnancy-related attack without adverse outcomes in patients with NMOSD.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Kim SH, Huh SY, Jang HM, et al. Long-term outcome of pregnant women with neuromyelitis optica spectrum disorder. Abstract presentation at: 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; September 11-13, 2019; Stockholm, Sweden. Abstract P1091.