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Evidence of disease activity during pregnancy and post-partum in MS patients treated with high-efficacy therapies.
Sahloul, Oussama; Louapre, Céline; Beigneux, Ysoline; Lubetzki, Catherine; Maillart, Elisabeth; Roux, Thomas.
Afiliação
  • Sahloul O; Neurology Department, Pitié-Salpêtrière University Hospital, Paris, France. Electronic address: oussama.sahloul@aphp.fr.
  • Louapre C; Neurology Department, Pitié-Salpêtrière University Hospital, Paris, France.
  • Beigneux Y; Neurology Department, Pitié-Salpêtrière University Hospital, Paris, France.
  • Lubetzki C; Neurology Department, Pitié-Salpêtrière University Hospital, Paris, France.
  • Maillart E; Neurology Department, Pitié-Salpêtrière University Hospital, Paris, France.
  • Roux T; Neurology Department, Pitié-Salpêtrière University Hospital, Paris, France.
Mult Scler Relat Disord ; 85: 105557, 2024 May.
Article em En | MEDLINE | ID: mdl-38520946
ABSTRACT

BACKGROUND:

Multiple sclerosis (MS) predominantly affects women of childbearing age. Due to the risk of teratogenicity, women with active multiple sclerosis (MS) who require high-efficacy therapies (HET) may need to discontinue treatment during pregnancy. Fingolimod and Natalizumab withdrawal increases the risk of disease reactivation, a risk not commonly associated with anti-CD20 therapies. However, comparative data are limited during pregnancy and post-partum. Our aim was to compare evidence of disease activity during pregnancy and post-partum in women treated with HET (anti-CD20 therapies, Natalizumab or Fingolimod) before conception, whether or not exposed during pregnancy.

METHODS:

In this single-center retrospective study, we included consecutive pregnancies of relapsing-remitting MS patients and classified them in three groups according to the last HET used before conception « anti-CD20 ¼ « Natalizumab (NTZ) ¼ and « Fingolimod (FGD) ¼. The main outcome was annualized relapse rate (ARR) during pregnancy and post-partum.

RESULTS:

We included 66 pregnancies 21, 24 and 21 in anti-CD20, NTZ and FGD groups respectively. Overall, mean ARR (SD) increased from 0.36 (0.6) during the preconception year to 0.60 (1.3) during pregnancy and to 1.03 (2.0) in the first 3 months post-partum. Mean ARR in anti-CD20 group (0.09 (0.3)) during pregnancy and the first 3 months post-partum was lower compared with NTZ (0.48 (0.6); p = 0,09) and FGD (1.50 (1.8); p = 0.001) groups. Proportion of pregnancies with radiological activity during pregnancy and post-partum in anti-CD20 group (5.2 %) was lower compared with NTZ (63.1 %; p < 0.001) and FGD (72.2 %; p < 0.001) groups. There was no significant difference in the evolution of EDSS score from conception to post-partum between each group (p = 0.75).

CONCLUSION:

Evidence of disease activity was significantly lower in patients exposed to anti-CD20 therapies before conception. This study suggests that use of anti-CD20 therapies is an efficient option to prevent disease reactivation during pregnancy and post-partum.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações na Gravidez / Esclerose Múltipla Recidivante-Remitente / Período Pós-Parto / Cloridrato de Fingolimode / Natalizumab / Fatores Imunológicos Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Mult Scler Relat Disord Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações na Gravidez / Esclerose Múltipla Recidivante-Remitente / Período Pós-Parto / Cloridrato de Fingolimode / Natalizumab / Fatores Imunológicos Limite: Adult / Female / Humans / Pregnancy Idioma: En Revista: Mult Scler Relat Disord Ano de publicação: 2024 Tipo de documento: Article