Sunday, 25 February 2018

Pregnancy

Pregnancy is an important issue with regard to MS, so we try and post the research even if we have nothing much to say



Portaccio E, Annovazzi P, Ghezzi A, Zaffaroni M, Moiola L, Martinelli V, Lanzillo R, Brescia Morra V, Rinaldi F, Gallo P, Tortorella C, Paolicelli D, Pozzilli C, De Giglio L, Cavalla P, Cocco E, Marrosu MG, Patti F, Solaro C, Bellantonio P, Uccelli A, Laroni A, Pastò L, Giannini M, Trojano M, Comi G, Amato MP; MS Study Group of the Italian Neurological Society. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Foetal risks. Neurology. 2018. pii: 10.1212/WNL.0000000000005067

OBJECTIVE:To assess fetal risk after pregnancy exposure to natalizumab in women with multiple sclerosis (MS), with a specific focus on spontaneous abortion (SA) and congenital anomalies (CA).
METHODS:Data of all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab and referring to 19 participating sites were collected and compared with those of pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. Rates of SA and CA were also compared with those reported in the Italian population. Multivariable logistic and linear regression models were performed.
RESULTS:A total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with SA (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.9-8.5, p < 0.001). However, the rate of SA (17.4%) was within the estimates for the general population, as well as the rate of major CA (3.7%). Moreover, exposure to natalizumab and interferon-β (IFN-β) was associated with lower length and weight of the babies (p < 0.001).
CONCLUSION:Our results showed that natalizumab exposure to up 12 weeks of gestation is associated with an increased risk of SA, although within the limits expected in the general population, whereas the risk of CA needs further investigation. Taking into account the high risk of disease reactivation after natalizumab suspension, pregnancy could be planned continuing natalizumab while strictly monitoring conception.

Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: II: Maternal risks.Portaccio E, Moiola L, Martinelli V, Annovazzi P, Ghezzi A, Zaffaroni M, Lanzillo R, Brescia Morra V, Rinaldi F, Gallo P, Tortorella C, Paolicelli D, Pozzilli C, De Giglio L, Cavalla P, Cocco E, Marrosu MG, Solaro C, Uccelli A, Laroni A, Pastò L, Giannini M, Trojano M, Comi G, Amato MP; MS Study Group of the Italian Neurological Society.
Neurology. 2018 Feb 7. pii: 10.1212/WNL.0000000000005068.

OBJECTIVE:To assess the risk of disease reactivation during pregnancy after natalizumab suspension in women with multiple sclerosis(MS).
METHODS:Data of all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab and referring to 19 participating sites were collected and compared with those of pregnancies in untreated patients and patients treated with injectable immunomodulatory agents through a 2-factor repeated measures analysis. Predictors of disease activity were assessed through stepwise multivariable logistic regression models.
RESULTS: A total of 92 pregnancies were tracked in 83 women receiving natalizumab. Among these pregnancies, 74 in 70 women resulted in live births, with a post-partum follow-up of at least 1 year, and were compared with 350 previously published pregnancies. Relapse rate during and after pregnancy was higher in women treated with natalizumab (p < 0.001). Longer natalizumab washout period was the only predictor of relapse occurrence during pregnancy (p = 0.001). Relapses in the post-partum year were related to relapses during pregnancy (p = 0.019) and early reintroduction of disease-modifying drugs (DMD; p = 0.021). Disability progression occurred in 16.2% of patients and was reduced by early reintroduction of DMD (p = 0.024).
CONCLUSIONS: Taken as a whole, our findings indicate that the combination of avoiding natalizumab washout and the early resumption of DMD after delivery could be the best option in the perspective of maternal risk. This approach must take into account possible foetal risks that need to be discussed with the mother and require further investigation.


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