Raed Alroughani1, Saeed Akhtar2, Maya Zeineddine3, Yehya El Kouzi3, Nabil K El Ayoubi3, Samar F Ahmed4, Raed Behbehani5, Samia J Khoury3, Jasem Y Al-Hashel6, Bassem I Yamout3. 1. Division of Neurology, Department of Medicine, Amiri Hospital, Arabian Gulf Street, Sharq 11013, Kuwait. Electronic address: alroughani@gmail.com. 2. Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Jabriya, Kuwait. 3. Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut, Beirut, Lebanon. 4. Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait; Department of Neurology and Psychiatry, Minia University, Minia, Egypt. 5. Department of Neuro-Ophthalmology, Al-Bahar Eye Center, Sabah Medical Area, Kuwait. 6. Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait; Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
Abstract
BACKGROUND: Relapse rate in women with Multiple Sclerosis (MS) is reduced during pregnancy especially in the third trimester according to the previous studies. OBJECTIVES: To measure the annual relapse rate (ARR) in women with MS during pregnancy. METHODS: A retrospective study was conducted using prospectively collected data from two MS registries in Kuwait and Lebanon. Demographics, clinical characteristics including relapses, disease modifying therapies (DMTs) and their washout periods were extracted. The annual relapse rates pre and post pregnancies were compared and the relationship between relapses and prior use of different DMTs was assessed. RESULTS: Data of 164 pregnancies (132 MS patients) was reviewed. Mean age and disease duration at the time of pregnancy confirmation were 32.4 ± 5.3 and 7.8 ± 4.7 years respectively. Most patients (91.7%; n = 121) were on DMTs in the year prior to pregnancy. The pre-pregnancy ARR was 0.10 (95% CI: 0.04 - 0.13), which increased to 0.20 (95% CI: 0.13- 0.29) during pregnancy. Most relapses occurred either during the 1st (ARR = 0.24; 95% CI: 0.12 - 0.44) or 3rd (ARR = 0.32; 95%CI: 0.17 - 0.53) trimesters. Fingolimod (31.8%) and natalizumab (22.7%) were the most commonly prescribed DMTs in patients who sustained relapses during pregnancy. The mean washout period was significantly longer among subjects with relapses (9.3 ± 6.6 vs. 2.5 ± 3.9; p < 0.001) than those of without relapses. CONCLUSIONS: Relapse rate during pregnancy was higher than previous studies conducted in patients on platform therapies or untreated. Longer washout period prior to conception was associated with increased relapses especially in fingolimod and natalizumab treated patients.
BACKGROUND: Relapse rate in women with Multiple Sclerosis (MS) is reduced during pregnancy especially in the third trimester according to the previous studies. OBJECTIVES: To measure the annual relapse rate (ARR) in women with MS during pregnancy. METHODS: A retrospective study was conducted using prospectively collected data from two MS registries in Kuwait and Lebanon. Demographics, clinical characteristics including relapses, disease modifying therapies (DMTs) and their washout periods were extracted. The annual relapse rates pre and post pregnancies were compared and the relationship between relapses and prior use of different DMTs was assessed. RESULTS: Data of 164 pregnancies (132 MSpatients) was reviewed. Mean age and disease duration at the time of pregnancy confirmation were 32.4 ± 5.3 and 7.8 ± 4.7 years respectively. Most patients (91.7%; n = 121) were on DMTs in the year prior to pregnancy. The pre-pregnancy ARR was 0.10 (95% CI: 0.04 - 0.13), which increased to 0.20 (95% CI: 0.13- 0.29) during pregnancy. Most relapses occurred either during the 1st (ARR = 0.24; 95% CI: 0.12 - 0.44) or 3rd (ARR = 0.32; 95%CI: 0.17 - 0.53) trimesters. Fingolimod (31.8%) and natalizumab (22.7%) were the most commonly prescribed DMTs in patients who sustained relapses during pregnancy. The mean washout period was significantly longer among subjects with relapses (9.3 ± 6.6 vs. 2.5 ± 3.9; p < 0.001) than those of without relapses. CONCLUSIONS: Relapse rate during pregnancy was higher than previous studies conducted in patients on platform therapies or untreated. Longer washout period prior to conception was associated with increased relapses especially in fingolimod and natalizumab treated patients.
Authors: Wei Zhen Yeh; Putu Ayu Widyastuti; Anneke Van der Walt; Jim Stankovich; Eva Havrdova; Dana Horakova; Karolina Vodehnalova; Serkan Ozakbas; Sara Eichau; Pierre Duquette; Tomas Kalincik; Francesco Patti; Cavit Boz; Murat Terzi; Bassem I Yamout; Jeannette Lechner-Scott; Patrizia Sola; Olga G Skibina; Michael Barnett; Marco Onofrj; Maria José Sá; Pamela Ann McCombe; Pierre Grammond; Radek Ampapa; Francois Grand'Maison; Roberto Bergamaschi; Daniele L A Spitaleri; Vincent Van Pesch; Elisabetta Cartechini; Suzanne Hodgkinson; Aysun Soysal; Albert Saiz; Melissa Gresle; Tomas Uher; Davide Maimone; Recai Turkoglu; Raymond Mm Hupperts; Maria Pia Amato; Franco Granella; Celia Oreja-Guevara; Ayse Altintas; Richard A Macdonell; Tamara Castillo-Trivino; Helmut Butzkueven; Raed Alroughani; Vilija G Jokubaitis Journal: Neurology Date: 2021-04-20 Impact factor: 9.910