Riley Bove1, Kelsey Rankin2, Chris Lin2, Chao Zhao2, Jorge Correale3, Kerstin Hellwig4, Laure Michel5, David A Laplaud5, Tanuja Chitnis6. 1. Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA. 3. Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina. 4. St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany. 5. CRTI Inserm U1064, Nantes, France; Service de Neurologie, CHU Nantes, Nantes, France. 6. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Five case series reported increased relapse risk after assisted reproductive technologies (ART) in women with multiple sclerosis (MS), but small numbers and heterogeneous study design limit broader conclusions. OBJECTIVE: To evaluate the risk of relapses after ART in an independent case series and in aggregated analyses of existing studies. METHODS: We compared annualized relapse rate (ARR) in the 3 months after, and 12 months before, ART in (1) an unpublished cohort (Boston: prospectively collected relapses; 22 ART cycles), (2i) data pooled from Boston and five published studies (164 cycles), and (2ii) a meta-analysis of all case series published by 2017 (220 cycles; PRISMA and MOOSE guidelines). RESULTS: In the Boston cohort, mean ARR was not higher after ART than before (mean: 0.18 ± 0.85 vs 0.27 ± 0.55, p = 0.58). In the pooled analyses, ARR was significantly higher after ART for all clinical scenarios, including varying ART protocols (p ⩽ 0.01 for each). The meta-analysis confirmed an increased ARR after ART (mean difference (MD) = 0.92, 95% confidence interval (CI) = [0.33, 1.51], p = 0.01). CONCLUSION: These pooled data support an increase in ARR following ART. Reasons for local variation in ARR after ART, and consideration of MS treatments during conception attempts, will be pursued.
BACKGROUND: Five case series reported increased relapse risk after assisted reproductive technologies (ART) in women with multiple sclerosis (MS), but small numbers and heterogeneous study design limit broader conclusions. OBJECTIVE: To evaluate the risk of relapses after ART in an independent case series and in aggregated analyses of existing studies. METHODS: We compared annualized relapse rate (ARR) in the 3 months after, and 12 months before, ART in (1) an unpublished cohort (Boston: prospectively collected relapses; 22 ART cycles), (2i) data pooled from Boston and five published studies (164 cycles), and (2ii) a meta-analysis of all case series published by 2017 (220 cycles; PRISMA and MOOSE guidelines). RESULTS: In the Boston cohort, mean ARR was not higher after ART than before (mean: 0.18 ± 0.85 vs 0.27 ± 0.55, p = 0.58). In the pooled analyses, ARR was significantly higher after ART for all clinical scenarios, including varying ART protocols (p ⩽ 0.01 for each). The meta-analysis confirmed an increased ARR after ART (mean difference (MD) = 0.92, 95% confidence interval (CI) = [0.33, 1.51], p = 0.01). CONCLUSION: These pooled data support an increase in ARR following ART. Reasons for local variation in ARR after ART, and consideration of MS treatments during conception attempts, will be pursued.
Authors: Vilija G Jokubaitis; Olga Skibina; Raed Alroughani; Ayse Altintas; Helmut Butzkueven; Sara Eichau; Yara Fragoso; Kerstin Hellwig; Stella E Hughes; Louise Rath; Anneke van der Walt; Orla Gray Journal: Ther Adv Neurol Disord Date: 2021-04-12 Impact factor: 6.570
Authors: Dessa Sadovnick; Maria Criscuoli; Irene Yee; Robert Carruthers; Alice Schabas; Penelope Smyth Journal: Mult Scler J Exp Transl Clin Date: 2021-07-15