Yuko Shimizu1, Kazuo Fujihara2, Takashi Ohashi3, Ichiro Nakashima4, Kazumasa Yokoyama5, Ryotaro Ikeguch3, Toshiyuki Takahashi2, Tatsuro Misu2, Satoru Shimizu6, Masashi Aoki4, Kazuo Kitagawa3. 1. Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan yshimizu@nij.twmu.ac.jp. 2. Department of Multiple Sclerosis Therapeutics, Graduate School of Medicine, Tohoku University, Sendai, Japan. 3. Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan. 4. Department of Neurology, Graduate School of Medicine, Tohoku University, Sendai, Japan. 5. Department of Neurology, Juntendo University, Tokyo, Japan. 6. Medical Research Institute, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Few reports describe the influence pregnancy has on the annualized relapse rate (ARR) in neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE: To examine pregnancy-related attacks (attacks during pregnancy or within 1 year postpartum) and identify the risk factors for an attack in Japanese NMOSD patients. METHODS: We retrospectively reviewed 139 Japanese women whom had aquaporin-4 (AQP4) antibody-positive NMOSD. Among the 114 patients with information, 47 women had 56 pregnancies. We compared the ARR before, during and after pregnancy. RESULTS: Of the 47 NMOSD patients with pregnancy, 22 women (46.8%) had a pregnancy-related attack of the disease (either an onset event or a relapse). The ARR was significantly higher in the first 3 months postpartum (1.80 ± 2.04), than before the pregnancy (0.57 ± 1.16; p = 0.0043) and did not significantly decrease during pregnancy. The ARR before hospitalization and treatment was analyzable in 55 patients without pregnancy and was 1.09 ± 1.17. Among the 11 patients with onset before pregnancy, nine patients had a pregnancy-related attack with a relapse in the previous year, and their immunosuppression was discontinued or made to be at low doses; while the two patients on higher-dose therapies were relapse-free. CONCLUSION: In the present study, pregnancy-related attack was common in NMOSD, and unlike in multiple sclerosis, the ARR was not reduced during pregnancy. Discontinued or insufficient immunosuppression appeared to increase the risk of pregnancy-related attack.
BACKGROUND: Few reports describe the influence pregnancy has on the annualized relapse rate (ARR) in neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE: To examine pregnancy-related attacks (attacks during pregnancy or within 1 year postpartum) and identify the risk factors for an attack in Japanese NMOSD patients. METHODS: We retrospectively reviewed 139 Japanese women whom had aquaporin-4 (AQP4) antibody-positive NMOSD. Among the 114 patients with information, 47 women had 56 pregnancies. We compared the ARR before, during and after pregnancy. RESULTS: Of the 47 NMOSD patients with pregnancy, 22 women (46.8%) had a pregnancy-related attack of the disease (either an onset event or a relapse). The ARR was significantly higher in the first 3 months postpartum (1.80 ± 2.04), than before the pregnancy (0.57 ± 1.16; p = 0.0043) and did not significantly decrease during pregnancy. The ARR before hospitalization and treatment was analyzable in 55 patients without pregnancy and was 1.09 ± 1.17. Among the 11 patients with onset before pregnancy, nine patients had a pregnancy-related attack with a relapse in the previous year, and their immunosuppression was discontinued or made to be at low doses; while the two patients on higher-dose therapies were relapse-free. CONCLUSION: In the present study, pregnancy-related attack was common in NMOSD, and unlike in multiple sclerosis, the ARR was not reduced during pregnancy. Discontinued or insufficient immunosuppression appeared to increase the risk of pregnancy-related attack.
Authors: Sven Jarius; Klemens Ruprecht; Ingo Kleiter; Nadja Borisow; Nasrin Asgari; Kalliopi Pitarokoili; Florence Pache; Oliver Stich; Lena-Alexandra Beume; Martin W Hümmert; Marius Ringelstein; Corinna Trebst; Alexander Winkelmann; Alexander Schwarz; Mathias Buttmann; Hanna Zimmermann; Joseph Kuchling; Diego Franciotta; Marco Capobianco; Eberhard Siebert; Carsten Lukas; Mirjam Korporal-Kuhnke; Jürgen Haas; Kai Fechner; Alexander U Brandt; Kathrin Schanda; Orhan Aktas; Friedemann Paul; Markus Reindl; Brigitte Wildemann Journal: J Neuroinflammation Date: 2016-09-27 Impact factor: 8.322
Authors: Eric C Klawiter; Riley Bove; Liene Elsone; Enrique Alvarez; Nadja Borisow; Melissa Cortez; Farrah Mateen; Maureen A Mealy; Jaime Sorum; Kerry Mutch; Sean M Tobyne; Klemens Ruprecht; Guy Buckle; Michael Levy; Dean Wingerchuk; Friedemann Paul; Anne H Cross; Anu Jacobs; Tanuja Chitnis; Brian Weinshenker Journal: Neurology Date: 2017-11-01 Impact factor: 9.910
Authors: Riley Bove; Liene Elsone; Enrique Alvarez; Nadja Borisow; Melissa M Cortez; Farrah J Mateen; Maureen A Mealy; Kerry Mutch; Sean Tobyne; Klemens Ruprecht; Guy Buckle; Michael Levy; Dean M Wingerchuk; Friedemann Paul; Anne H Cross; Brian Weinshenker; Anu Jacob; Eric C Klawiter; Tanuja Chitnis Journal: Neurol Neuroimmunol Neuroinflamm Date: 2017-03-24