Contributions
Abstract: P323
Type: Poster
Abstract Category: Clinical aspects of MS - MS and gender
Background: Multiple sclerosis (MS) is possibly mediated by sex hormones as evidenced by the apparent influence of gender on disease susceptibility and disease course, and the favourable effect of pregnancy on MS. The menstrual cycle has been found to have an influence on several autoimmune diseases. In MS, studies have reported MS symptom worsening during the menstrual period with percentages ranging from 43% to 82%.
Objective: To investigate women reporting menstrual MS symptom worsening and to explore differences between women reporting symptom worsening and those that do not.
Methods: Our sample is comprised of a sub-group of 477 women with MS registered with the New York State MS Consortium (NYSMSC) who completed an extensive questionnaire inquiring on reproductive events. Demographic and clinical characteristics were compared between women who indicated that their menstrual period negatively affected their MS symptoms and those who reported it did not. All results were adjusted for age and disease duration using logistic regression.
Results: Of the 443 women who responded to the question, 74 (16.7%) reported that their menstrual periods negatively affected MS symptoms. Those affected were younger at symptom onset (25.4±8.4 vs 30.5±10.1, p=.001), more likely to use an assistive device (47.2% vs. 36.0%, p=.03) and were younger when first starting to use a cane (40.0±9.7 vs 46.4±10.8, p=.04). Furthermore, in a subgroup of menopausal women, patients who reported having had worse MS symptoms during their menstrual period were also more likely to report feeling worse after menopause (30.6% vs 16.9%, p=.002). There were no differences in contraceptive use or disease duration.
Conclusion: 16.7% of women in our sample reported complaints of MS symptom deterioration during their menstrual period, a percentage lower than found in other studies. Individual susceptibility to cyclic sex hormone changes which in turn can influence the immune system may explain why some report symptom worsening. The fact that the group reporting menses-related worsening of MS symptoms had significantly lower age at disease onset and higher use of an assistive device may indicate that this is a unique at-risk subset of patients. Although we did not find a difference in (hormone-based) contraceptive use between the groups, future studies should investigate if this subgroup might benefit from certain hormonal medication.
Disclosure: Katelyn Kavak: nothing to disclose.
Caila Vaughn: nothing to disclose.
Barbara Teter: received grant and/or research support from Biogen Idec, Teva Neuroscience, EMD Serono, Avanir, Genzyme and Novartis
Muhammad Nadeem: nothing to disclose.
Karen Zakalik: nothing to disclose.
Patricia Coyle: receives consulting fees from AbbVie, Accordant, Acorda, Bayer, Biogen, Genentech/Roche, Genzyme/Sanofi, Mallinckrodt, Novartis, Serono, and Teva. She also receives research support from Actelion, Genentech/Roche, NINDS, Novartis, and Opexa.
Lauren Krupp: received either consulting fees, honoraria, or royalty payments from the following: Biogen, Pfizer, Teva Neurosciences, EMD Serono, Janseen, Biogen, Novartis, Abbvie.
Megan Hyland: Dr. Hyland´s employer, the University of Rochester, has received research support from Novartis and Chugai.
Burk Jubelt: received Clinical Trial Grants from: Sanofi-Aventis (Relapsing MS/Teriflunomide), Genzyme (MS/Alemtuzumab), Novartis (Secondary Progressive MS/Fingolimod/Siponimod), Grifols (Post Polio Syndrome/Flebogamma), Receptos (MS/RPC1063), NY Stem Cell Program (Secondary Progressive MS), NIH/NINDS (SUNY Next Clinical Site), Clinical Studies: Biogen-Idec, Continuing Medical Education Speaker:CMEducation Resources LLC,Prime Education, Inc., Patient Education Speaker: National Multiple Sclerosis Society, Multiple Sclerosis Resources of Central New York.
Malcolm Gottesman: has served as a consultant for Biogen, Teva, and Genzyme.
Keith Edwards: Consulting services: Biogen, Genzyme. Speaker bureaus: Biogen, Genzyme. Research support: Actelion, Biogen, Eisai, Eli Lilly, Forum Pharmaceuticals, Genentech, Genzyme/Sanofi, Hoffmann-La Roche, Merz Pharmaceuticals, Novartis, Pfizer, Vaccinex.
Bianca Weinstock-Guttman: has received personal compensation for consulting, speaking and serving on a scientific advisory board for Biogen Idec, Teva Neuroscience, EMD Serono, Novartis, Questcor and Genzyme& Sanofi and has received financial support for research activities from NMSS, NIH (not for the present study), ITN, Teva Neuroscience, Biogen Idec, EMD Serono, Aspreva, Novartis, Genzyme.
Abstract: P323
Type: Poster
Abstract Category: Clinical aspects of MS - MS and gender
Background: Multiple sclerosis (MS) is possibly mediated by sex hormones as evidenced by the apparent influence of gender on disease susceptibility and disease course, and the favourable effect of pregnancy on MS. The menstrual cycle has been found to have an influence on several autoimmune diseases. In MS, studies have reported MS symptom worsening during the menstrual period with percentages ranging from 43% to 82%.
Objective: To investigate women reporting menstrual MS symptom worsening and to explore differences between women reporting symptom worsening and those that do not.
Methods: Our sample is comprised of a sub-group of 477 women with MS registered with the New York State MS Consortium (NYSMSC) who completed an extensive questionnaire inquiring on reproductive events. Demographic and clinical characteristics were compared between women who indicated that their menstrual period negatively affected their MS symptoms and those who reported it did not. All results were adjusted for age and disease duration using logistic regression.
Results: Of the 443 women who responded to the question, 74 (16.7%) reported that their menstrual periods negatively affected MS symptoms. Those affected were younger at symptom onset (25.4±8.4 vs 30.5±10.1, p=.001), more likely to use an assistive device (47.2% vs. 36.0%, p=.03) and were younger when first starting to use a cane (40.0±9.7 vs 46.4±10.8, p=.04). Furthermore, in a subgroup of menopausal women, patients who reported having had worse MS symptoms during their menstrual period were also more likely to report feeling worse after menopause (30.6% vs 16.9%, p=.002). There were no differences in contraceptive use or disease duration.
Conclusion: 16.7% of women in our sample reported complaints of MS symptom deterioration during their menstrual period, a percentage lower than found in other studies. Individual susceptibility to cyclic sex hormone changes which in turn can influence the immune system may explain why some report symptom worsening. The fact that the group reporting menses-related worsening of MS symptoms had significantly lower age at disease onset and higher use of an assistive device may indicate that this is a unique at-risk subset of patients. Although we did not find a difference in (hormone-based) contraceptive use between the groups, future studies should investigate if this subgroup might benefit from certain hormonal medication.
Disclosure: Katelyn Kavak: nothing to disclose.
Caila Vaughn: nothing to disclose.
Barbara Teter: received grant and/or research support from Biogen Idec, Teva Neuroscience, EMD Serono, Avanir, Genzyme and Novartis
Muhammad Nadeem: nothing to disclose.
Karen Zakalik: nothing to disclose.
Patricia Coyle: receives consulting fees from AbbVie, Accordant, Acorda, Bayer, Biogen, Genentech/Roche, Genzyme/Sanofi, Mallinckrodt, Novartis, Serono, and Teva. She also receives research support from Actelion, Genentech/Roche, NINDS, Novartis, and Opexa.
Lauren Krupp: received either consulting fees, honoraria, or royalty payments from the following: Biogen, Pfizer, Teva Neurosciences, EMD Serono, Janseen, Biogen, Novartis, Abbvie.
Megan Hyland: Dr. Hyland´s employer, the University of Rochester, has received research support from Novartis and Chugai.
Burk Jubelt: received Clinical Trial Grants from: Sanofi-Aventis (Relapsing MS/Teriflunomide), Genzyme (MS/Alemtuzumab), Novartis (Secondary Progressive MS/Fingolimod/Siponimod), Grifols (Post Polio Syndrome/Flebogamma), Receptos (MS/RPC1063), NY Stem Cell Program (Secondary Progressive MS), NIH/NINDS (SUNY Next Clinical Site), Clinical Studies: Biogen-Idec, Continuing Medical Education Speaker:CMEducation Resources LLC,Prime Education, Inc., Patient Education Speaker: National Multiple Sclerosis Society, Multiple Sclerosis Resources of Central New York.
Malcolm Gottesman: has served as a consultant for Biogen, Teva, and Genzyme.
Keith Edwards: Consulting services: Biogen, Genzyme. Speaker bureaus: Biogen, Genzyme. Research support: Actelion, Biogen, Eisai, Eli Lilly, Forum Pharmaceuticals, Genentech, Genzyme/Sanofi, Hoffmann-La Roche, Merz Pharmaceuticals, Novartis, Pfizer, Vaccinex.
Bianca Weinstock-Guttman: has received personal compensation for consulting, speaking and serving on a scientific advisory board for Biogen Idec, Teva Neuroscience, EMD Serono, Novartis, Questcor and Genzyme& Sanofi and has received financial support for research activities from NMSS, NIH (not for the present study), ITN, Teva Neuroscience, Biogen Idec, EMD Serono, Aspreva, Novartis, Genzyme.