Use of the oral contraceptive pill associated with a better outcomes. Why? #MSBlog #MSResearch
"Please don't forget about reverse causation; instead of COCs having a favourable effect on MS could more benign MSers be more likely to be taking COCs? For example, they may be less disabled, less depressed and have better quality of life and hence more likely to be sexually active and more likely to be not wanting to fall pregnant."
Epub: Gava et al. Long-term influence of combined oral contraceptive use on the clinical course of relapsing-remittingmultiple sclerosis. Fertil Steril. 2014 Apr 29.
OBJECTIVE: To assess the long-term effects of combined oral contraceptives (COCs) on the clinical course of relapsing-remitting multiple sclerosis (RRMS), focusing on disability progression and evolution to secondary-progressive multiple sclerosis (SPMS).
PATIENT(S): A total of 174 women with clinically confirmed MS; of these, 33 had evolved to SPMS at the time of enrollment in the study, whereas 141 still had a relapsing-remitting form of disease.
MAIN OUTCOME MEASURE(S): Expanded Disability Status Scale (EDSS); Multiple Sclerosis Severity Score (MSSS); annualized relapse rate; evolution to SPMS.
RESULT(S): Mean ± SD duration of disease was 14.3 ± 9.8 years. Compared with non-users of COCs, COC users had lower EDSS scores and MSSS only in the subset of the population with prior or current immunomodulatory treatment. Non-use of COCs was a predictor of disease evolution in SPMS, whether treated or not with immunomodulatory drugs. The annualized relapse rate was not influenced by COC use. No differences in EDSS scores and evolution to SPMS depending on COC formulation were detected.
CONCLUSION(S): Our results suggest that COC use is associated with a less severe disease and less severe evolution. Whether different doses or types of progestin may have different effects remains to be defined.