Women with relapsing multiple sclerosis (MS) who have exposure to disease-modifying drugs (DMDs) in early pregnancy have fewer postpartum relapses, according to study results presented at the 2021 Consortium of Multiple Sclerosis Centers Annual Meeting.
MS relapses tend to decrease during pregnancy, but previous research suggests there’s an increased risk for relapse in the first months postpartum. The objective of the current study was to determine whether the use of DMDs could influence the risk of postpartum relapse in women with MS.
In a systematic review, researchers searched the Embase and MEDLINE databases for relevant studies published from November 2009 to 2019. A total of 17 studies that reported postpartum relapse data were included.
The studies had a combined 2522 patients and 2803 pregnancies—1611 pregnancies were exposed to DMDs during preconception, 451 during pregnancy, and 540 in postpartum. Postpartum relapses were reported primarily as relapse rate (RR; n=6 [range 0.1-0.6]) and annualized RR (n=5 [range 0.2-1.1]).
Exposure to DMDs in early pregnancy was associated with fewer postpartum relapses (DMD: platform therapy, n = 2; intravenous [IV] infusion, n = 1) vs no DMD exposure in 3 of 4 studies. The other study found no difference between groups (patients with relapses exposed to DMDs, 23%; unexposed, 27%).
DMD exposure preconception had no effect in general regarding postpartum relapses (DMD: various, n=3) compared with no DMD exposure, although 1 study found that high-efficacy DMD use (IV infusion or oral) preconception was associated with postpartum relapse (odds ratio 2.11; 95% CI, 1.32-3.27) vs no high-efficacy DMD use.
Some studies indicated that restarting DMDs during early postpartum decreased the number of relapses compared with a delayed restart (DMD: various, n=3; IV infusion, n=2). Other studies found no significant effect on relapse risk (DMD: various, n=3).
“Findings regarding postpartum relapses in women with MS exposed to DMDs were varied,” stated the researchers. “In terms of clinical disease activity, decision-making concerning benefit-risk of DMD use before, during, and after pregnancy remains difficult.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Hellwig K, Verdun di Cantogno E, Sabidó M. Postpartum relapse rates in women with relapsing multiple sclerosis and the impact of disease-modifying drugs: a systematic review. Presented at: CMSC 2021 Annual Meeting; October 25-28, 2021; Orlando, Florida. Abstract DMT02.