@article {Portaccio845, author = {Emilio Portaccio and Angelo Ghezzi and Bahia Hakiki and Andrea Sturchio and Vittorio Martinelli and Lucia Moiola and Francesco Patti and Gian Luigi Mancardi and Claudio Solaro and Maria Rosaria Tola and Carlo Pozzilli and Laura De Giglio and Rocco Totaro and Alessandra Lugaresi and Giovanna De Luca and Damiano Paolicelli and Maria Giovanna Marrosu and Giancarlo Comi and Maria Trojano and Maria Pia Amato and for the MS Study Group of the Italian Neurological Society}, editor = {Amato, MP and Portaccio, E and Hakiki, B and Sturchio, A and Past{\`o}, L and Giannini, M and Razzolini, L and Piscolla, E and Siracusa, G and Ghezzi, A and Rizzo, A and Zaffaroni, M and Martinelli, V and Radaelli, M and Moiola, L and Comi, G and Protti, A and Spreafico, C and Marazzi, R and Cavalla, P and Masera, S and Bergamaschi, R and Mancardi, G and Capello, E and Solaro, C and Tola, MR and Caniatti, L and Granella, F and Immovilli, P and Annunziata, P and De Santi, L and Plewnia, K and Guidi, L and Bartolozzi, ML and Mazzoni, M. and Pozzilli, C and De Giglio, L and Totaro, R and Carolei, A and Rossi, M and Lugaresi, A and De Luca, G. and Di Tommaso, V and Trojano, M and Paolicelli, D and Carrozzo, A and D{\textquoteright}Onghia, M and Marrosu, MG and Musu, L and Patti, F and Carmela, L and Lo Fermo, S}, title = {Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs}, volume = {85}, number = {8}, pages = {845--850}, year = {2014}, doi = {10.1136/jnnp-2013-306054}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective To assess relapses, disability progression and the role of disease modifying drugs (DMDs) in the year after delivery in women with multiple sclerosis (MS). Methods We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centres. The risk of relapses and disability progression in the year after delivery was assessed using time-dependent Cox regression analysis. Results 350 out of 423 pregnancies were assessed (pregnancies not resulting in live birth and with a postpartum follow-up period shorter than 1 year were excluded from the analysis). 148 patients (42.3\%) had at least one relapse in the year after delivery. An Expanded Disability Status Scale (EDSS) score at conception >=2.0 (HR=1.4; 95\% CI 1.1 to 2.0; p=0.046) and a higher number of relapses before (HR=1.5; 95\% CI 1.2 to 1.8; p\<0.001) and during pregnancy (HR=2.3; 95\% CI 1.6 to 3.4; p\<0.001) were related to a higher risk of postpartum relapses. On the contrary, early DMD resumption after delivery marginally reduced the risk of postpartum relapses (HR=0.7, 95\% CI 0.4 to 1.0; p=0.079). Moreover, 44/338 women progressed by at least one point on the EDSS. Disability progression was associated with a higher number of relapses before (HR=1.4, 95\% CI 1.1 to 1.9; p=0.047) and after delivery (HR=2.7, 95\% CI 1.4 to 5.2; p=0.002). Conclusions Our findings show an increased risk of postpartum relapses and disability accrual in women with higher disease activity before and during pregnancy. Since it may reduce the risk of postpartum relapses, early DMD resumption should be encouraged, particularly in patients with more active disease.}, issn = {0022-3050}, URL = {https://jnnp.bmj.com/content/85/8/845}, eprint = {https://jnnp.bmj.com/content/85/8/845.full.pdf}, journal = {Journal of Neurology, Neurosurgery \& Psychiatry} }