Abstract
Introduction: Trends of disease activity during pregnancy, the postpartum period, and until 24 months from the delivery in the era of new drugs for the treatment of relapsing-remitting multiple sclerosis (RRMS) need to be investigated.Methods: In this cross-sectional Italian multicenter study, women with RRMS were included; the disease-modifying treatment (DMT) at the time of conception included were: interferons, glatiramer acetate, teriflunomide, dimethyl fumarate, fingolimod, and natalizumab. The main outcome of the study was to determine the rate of relapse occurrence during pregnancy and the postpartum period in all women grouped for each DMT. The secondary outcome was to determine the overall disease activity assessed by NEDA 3 (relapse, disability level, and radiological activity) at 24 months from the date of delivery.Results: Completed data were available for 81 pregnancies (in 74 women). Women on interferons and glatiramer had longer disease duration than women on dimethyl fumarate, fingolimod, and natalizumab (p < 0.05). Overall, we recorded 25 relapses during pregnancy (11 in 11 women) and the postpartum period (14 in 14 women). Natalizumab was the most commonly DMT in women (3) who experienced relapses during pregnancy. IFNs were the most commonly prescribed DMT in women (8) who experienced relapses during the postpartum period. At logistic regression analysis, specific treatment per se was not associated with relapse occurrence. No differences among the DMTs groups were recorded about NEDA 3 status at 24 months of follow-up.Conclusions: In our population, there was no difference in terms of relapses occurrence, disability status, and the overall disease activity during a follow up of 24 months.
Highlights
Trends of disease activity during pregnancy, the postpartum period, and until 24 months from the delivery in the era of new drugs for the treatment of relapsing-remitting multiple sclerosis (RRMS) need to be investigated
The main outcome of the study was to determine the rate of relapse occurrence during pregnancy and the postpartum period in all women grouped for each disease-modifying treatments (DMTs)
No differences among the DMTs groups were recorded about NEDA 3 status at 24 months of follow-up
Summary
Trends of disease activity during pregnancy, the postpartum period, and until 24 months from the delivery in the era of new drugs for the treatment of relapsing-remitting multiple sclerosis (RRMS) need to be investigated. In women with the relapsing-remitting form of multiple sclerosis (RRMS), pregnancy still represents a challenge in terms of what to do before, during, and after such an event [1]. The CD56 natural killer cells might play an active role in the reduction of disease activity during the third trimester [11]. With the advent of new and potent—but less safe—disease-modifying treatments (DMTs) for RRMS, new issues in terms of management and pregnancy have arisen; of these, the timing of DMT wash-out prepregnancy, use during pregnancy, restart therapy after delivery, and the risk of disease activity rebound represent the most challenging. Literature provides data mainly for women who were on either interferon beta (IFN-β) or glatiramer acetate (GA) before conception [12,13,14,15,16,17,18], while few reports are disposable for the women on DMTs, which were released onto the market more recently [19,20,21]
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