Rates of Multiple Sclerosis Relapses Vary Before, During, and After Pregnancy

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Disease-modifying drug treatment remained low during pregnancy and 6 weeks postpartum but increased significantly by 12 months post pregnancy.
Disease-modifying drug treatment remained low during pregnancy and 6 weeks postpartum but increased significantly by 12 months post pregnancy.

Relapses of multiple sclerosis decrease during pregnancy, increase 6 weeks postpartum, and decrease 6 to 12 months postpartum, according to a study published in Neurology.

Researchers in this retrospective study evaluated data from women (N=2158) who were diagnosed with multiple sclerosis from the IQVIA Real-World Data Adjudicated Claims–US database to analyze the frequency of multiple sclerosis relapses and the use of disease-modifying drugs before pregnancy, during pregnancy, and postpartum. Relapses were defined as a multiple sclerosis-related hospitalization, emergency department visit, or an outpatient visit with a corticosteroid prescription. Disease-modifying drugs could include self-injectables, oral medications, or infusions.

When compared with before pregnancy, the odds of relapse during pregnancy decreased (OR 0.623; 95% CI, 0.521-0.744, P <.0001), while the odds of relapse during the first 6 weeks postpartum increased (OR 1.710; 95% CI, 1.358-2.152, P <.0001) and the odds of relapse during the last 3 postpartum quarters increased (OR 1.216; 95% CI, 1.052-1.406, P =.0081). Overall, most relapses were treated at an outpatient facility, and relapses treated during an emergency department visit remained constant throughout the study time frame (P >.05). The odds of a relapse requiring hospitalization were the highest during the third trimester (OR 1.849; 95% CI, 1.280-2.670, P =.0011) and the first 6 weeks after delivery (OR 2.315; 95% CI, 1.478-3.626, P =.0002). Disease-modifying drug treatment remained low during pregnancy and 6 weeks postpartum but increased significantly by 12 months post pregnancy (OR 1.259; 95% CI, 1.156-1.371, P <.0001). At 12 months post pregnancy, 28.5% of patients initiated disease-modifying drugs, with 47.8% of these occurring by 90-days post delivery.

Future prospective studies need to examine the practical and clinical outcomes for both mother and child in regards to relapses and disease-modifying drug treatments.

In conclusion, relapses of multiple sclerosis decrease during pregnancy and the use of disease-modifying drugs increase postpartum. This retrospective analysis lays the groundwork for furthering the understanding of “practice patterns and neurologic, obstetric, and pediatric outcomes in this patient population.”

This study was supported by EMD Serono, Inc. Please refer to reference for a complete list of authors' disclosures.

Reference

Houtchens MK, Edwards NC, Phillips AL. Relapses and disease-modifying drug treatment in pregnancy and live birth in US women with MS. Neurology. 2018; 91(17):e1570-e1578.

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