Portal de Periódicos da CAPES

Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs

2014; BMJ; Volume: 85; Issue: 8 Linguagem: Inglês

10.1136/jnnp-2013-306054

1468-330X

Emilio Portaccio, Angelo Ghezzi, Bahia Hakiki, Andrea Sturchio, Vittorio Martinelli, Lucia Moiola, Francesco Patti, Gianluigi Mancardi, Claudio Solaro, M. R. Tola, Carlo Pozzilli, Laura De Giglio, Rocco Totaro, Alessandra Lugaresi, Giovanna De Luca, Damiano Paolicelli, Maria Giovanna Marrosu, Gıancarlo Comı, Maria Trojano, Maria Pia Amato, Maria Pia Amato, Emilio Portaccio, Bahia Hakiki, Andrea Sturchio, Luisa Pastò, Marta Giannini, Lorenzo Razzolini, E. Piscolla, G. Siracusa, Angelo Ghezzi, A. Rizzo, Mauro Zaffaroni, Vittorio Martinelli, Marta Radaelli, Lucia Moiola, Gıancarlo Comı, Alessandra Protti, C. Spreafico, R. Marazzi, Paola Cavalla, Silvia Masera, Roberto Bergamaschi, Gianluigi Mancardi, Elisabetta Capello, Claudio Solaro, M. R. Tola, Luisa Caniatti, Franco Granella, Paolo Immovilli, Pasquale Annunziata, Lorenzo De Santi, Katrin Plewnia, Leonello Guidi, M. Bartolozzi, Maria Rosa Mazzoni, Carlo Pozzilli, Laura De Giglio, Rocco Totaro, A Carolei, Mariateresa Rossi, Alessandra Lugaresi, Giovanna De Luca, V. Di Tommaso, Maria Trojano, Damiano Paolicelli, Alessandro Carrozzo, Martina D’Onghia, Maria Giovanna Marrosu, Luigina Musu, Francesco Patti, L. Carmela, Salvatore Lo Fermo,

Pregnancy and Medication Impact

Objective To assess relapses, disability progression and the role of disease modifying drugs (DMDs) in the year after delivery in women with multiple sclerosis (MS). Methods We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centres. The risk of relapses and disability progression in the year after delivery was assessed using time-dependent Cox regression analysis. Results 350 out of 423 pregnancies were assessed (pregnancies not resulting in live birth and with a postpartum follow-up period shorter than 1 year were excluded from the analysis). 148 patients (42.3%) had at least one relapse in the year after delivery. An Expanded Disability Status Scale (EDSS) score at conception ≥2.0 (HR=1.4; 95% CI 1.1 to 2.0; p=0.046) and a higher number of relapses before (HR=1.5; 95% CI 1.2 to 1.8; p<0.001) and during pregnancy (HR=2.3; 95% CI 1.6 to 3.4; p<0.001) were related to a higher risk of postpartum relapses. On the contrary, early DMD resumption after delivery marginally reduced the risk of postpartum relapses (HR=0.7, 95% CI 0.4 to 1.0; p=0.079). Moreover, 44/338 women progressed by at least one point on the EDSS. Disability progression was associated with a higher number of relapses before (HR=1.4, 95% CI 1.1 to 1.9; p=0.047) and after delivery (HR=2.7, 95% CI 1.4 to 5.2; p=0.002). Conclusions Our findings show an increased risk of postpartum relapses and disability accrual in women with higher disease activity before and during pregnancy. Since it may reduce the risk of postpartum relapses, early DMD resumption should be encouraged, particularly in patients with more active disease.