RT Journal Article
SR Electronic
T1 Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 845
OP 850
DO 10.1136/jnnp-2013-306054
VO 85
IS 8
A1 Portaccio, Emilio
A1 Ghezzi, Angelo
A1 Hakiki, Bahia
A1 Sturchio, Andrea
A1 Martinelli, Vittorio
A1 Moiola, Lucia
A1 Patti, Francesco
A1 Mancardi, Gian Luigi
A1 Solaro, Claudio
A1 Tola, Maria Rosaria
A1 Pozzilli, Carlo
A1 De Giglio, Laura
A1 Totaro, Rocco
A1 Lugaresi, Alessandra
A1 De Luca, Giovanna
A1 Paolicelli, Damiano
A1 Marrosu, Maria Giovanna
A1 Comi, Giancarlo
A1 Trojano, Maria
A1 Amato, Maria Pia
A1 ,
YR 2014
UL http://jnnp.bmj.com/content/85/8/845.abstract
AB 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.