Contributions
Abstract: P327
Type: Poster
Abstract Category: Clinical aspects of MS - MS and gender
Background: Counselling of pregnant women who have an active disease course of multiple sclerosis (MS) is important.
Objective: to evaluate the disease course during and up to 6 months after pregnancy in patients with active MS.
Methods: We collected data and assessed the disease course of 23 women with 27 pregnancies prior, during and after pregnancy.
Results: 19 women with 23 pregnancies were treated with natalizumab (NAT) and 4 with fingolimod (FTY) prior to pregnancy. Overall, 29 relapses were recorded, 19 during pregnancy and 10 postpartum. 15 patients stopped NAT at the beginning of their pregnancy and three (20%) remained stable throughout pregnancy without recurrence of disease activity. 10 (67%) experienced relapses during pregnancy 7 (+/- 3) months after cessation of NAT. One resumed NAT during the 30th week of gestation due to ongoing disease activity and remained stable thereafter. 7/15 (47%) had postpartal relapses, 5 (33%) showed disease activity at during pregnancy as well as postpartum. In three pregnancies NAT treatment was stopped at 12 weeks of gestation; in two of them relapses occurred during the third trimester. Continuous use of NAT in five women during pregnancy as well as postpartum was accompanied by an entirely stable disease course in all of them. 9 women who stopped NAT during pregnancy restarted NAT early after delivery and remained stable thereafter. All four patients who were treated with FTY prior to pregnancy experienced relapses during pregnancy. Discontinuation of FTY two months prior to pregnancy resulted in severe relapses during the first trimester in three patients, and in one relapse postpartum in one of them. One woman who accidentally took FTY until early pregnancy experienced a relapse during the third trimester.
So far, 25 deliveries have been recorded, and 23 healthy babies were born, two pregnancies are ongoing. One baby exposed to NAT as well as valproic acid for epilepsy was born with a congenital heart defect, and the baby who was exposed to NAT since the 30th week of gestation was born with anal atresia.
Conclusions: Women who stop FTY or NAT prior to, or during the first trimester of pregnancy have a high risk for increased disease activity during pregnancy and/or postpartum compared to women who continue NAT therapy during pregnancy. Continuous use of NAT throughout pregnancy can be an option for women with active MS and should be considered as an individual option in selected cases.
Disclosure: RH has received grant support from Bayer, Biogen, Genzyme-Sanofi, Merck-Serono, Novartis, Teva and personal fees from Actelion, Bayer, Biogen, Genzyme-Sanofi, Medday, Merck-Serono, Novartis, Roche, and Teva.
TK has received travel expenses and personal compensations for from Bayer Healthcare, Teva Pharma, Merck-Serono, Novartis Pharma, Sanofi-Aventis/Genzyme and Biogen-Idec as well as grant support from Bayer-Schering AG and Novartis Pharma.
IM has received travel expense compensation from Teva and Biogen-Idec
Abstract: P327
Type: Poster
Abstract Category: Clinical aspects of MS - MS and gender
Background: Counselling of pregnant women who have an active disease course of multiple sclerosis (MS) is important.
Objective: to evaluate the disease course during and up to 6 months after pregnancy in patients with active MS.
Methods: We collected data and assessed the disease course of 23 women with 27 pregnancies prior, during and after pregnancy.
Results: 19 women with 23 pregnancies were treated with natalizumab (NAT) and 4 with fingolimod (FTY) prior to pregnancy. Overall, 29 relapses were recorded, 19 during pregnancy and 10 postpartum. 15 patients stopped NAT at the beginning of their pregnancy and three (20%) remained stable throughout pregnancy without recurrence of disease activity. 10 (67%) experienced relapses during pregnancy 7 (+/- 3) months after cessation of NAT. One resumed NAT during the 30th week of gestation due to ongoing disease activity and remained stable thereafter. 7/15 (47%) had postpartal relapses, 5 (33%) showed disease activity at during pregnancy as well as postpartum. In three pregnancies NAT treatment was stopped at 12 weeks of gestation; in two of them relapses occurred during the third trimester. Continuous use of NAT in five women during pregnancy as well as postpartum was accompanied by an entirely stable disease course in all of them. 9 women who stopped NAT during pregnancy restarted NAT early after delivery and remained stable thereafter. All four patients who were treated with FTY prior to pregnancy experienced relapses during pregnancy. Discontinuation of FTY two months prior to pregnancy resulted in severe relapses during the first trimester in three patients, and in one relapse postpartum in one of them. One woman who accidentally took FTY until early pregnancy experienced a relapse during the third trimester.
So far, 25 deliveries have been recorded, and 23 healthy babies were born, two pregnancies are ongoing. One baby exposed to NAT as well as valproic acid for epilepsy was born with a congenital heart defect, and the baby who was exposed to NAT since the 30th week of gestation was born with anal atresia.
Conclusions: Women who stop FTY or NAT prior to, or during the first trimester of pregnancy have a high risk for increased disease activity during pregnancy and/or postpartum compared to women who continue NAT therapy during pregnancy. Continuous use of NAT throughout pregnancy can be an option for women with active MS and should be considered as an individual option in selected cases.
Disclosure: RH has received grant support from Bayer, Biogen, Genzyme-Sanofi, Merck-Serono, Novartis, Teva and personal fees from Actelion, Bayer, Biogen, Genzyme-Sanofi, Medday, Merck-Serono, Novartis, Roche, and Teva.
TK has received travel expenses and personal compensations for from Bayer Healthcare, Teva Pharma, Merck-Serono, Novartis Pharma, Sanofi-Aventis/Genzyme and Biogen-Idec as well as grant support from Bayer-Schering AG and Novartis Pharma.
IM has received travel expense compensation from Teva and Biogen-Idec