Contributions
Abstract: EP1355
Type: ePoster
Abstract Category: Clinical aspects of MS - 6 MS and gender
Background: The effect of pregnancy on long-term disability in women with relapsing-remitting multiple sclerosis (MS) is poorly understood.
Aim: To determine the association between delaying Disease Modifying Therapy (DMT) for pregnancy planning and long-term disability, as measured by the expanded disability status scale (EDSS), in women with relapsing-remitting MS.
Methods: Using data from the Calgary MS Clinic database, we identified 426 women with EDSS < 5, who delayed starting DMT for more than one year after it was recommended during the period 1999 to 2006. Thirty-seven consenting women declined DMT due to planned pregnancy. EDSS at diagnosis was compared with EDSS at 5, 7, 10 and 15 years. The association between the cumulative time on DMT during the first 5 years of MS and EDSS change at 5, 7, 10, and 15 years was determined. EDSS change was compared with EDSS change in a control group of 101 women with relapsing-remitting MS (diagnosed between 18-40 years) who declined DMT for other reasons.
Results: Mean follow-up after diagnosis was 14.05 years. Prior to the diagnosis of MS 86.5% were nulliparous compared with 19% at the end of follow-up. Mean time to pregnancy was 2.38 years from MS diagnosis and 0.84 years from declining DMT for pregnancy. Eventually, 67.6% of the patients started DMT. Mean time to initiating DMT was 4.02 years after declining DMT for pregnancy. Confirmed relapses occurred in 70.3% of women between declining DMT due to pregnancy and starting DMT; the mean time to a relapse was 1.92 years. There was an increase in the mean EDSS score 15 years after diagnosis of 1.13 points (paired t-test, p= 0.002) among women declined DMT for pregnancy planning. There was a moderate to high moderate negative correlation between the cumulative time on DMT during the first 5 years after the diagnosis of MS and EDSS change at 7 (R= -0.49, p=0.008), 10 (R= -0.44, p=0.017), and 15 (R= -0.67, p=0.006) years. When compared to the control group who delayed DMT for other reasons, change in EDSS at 5, 7, 10, and 15 years was not significant even after adjustment for age.
Conclusion: Delaying DMT initiation for a planned pregnancy did not have a major impact of disability over 15 years in our patients despite the frequent occurrence of relapses and statistically significant change in EDSS. Greater time on DMT during the first 5 years after their MS diagnosis was associated with a statistically significant reduction in EDSS change.
Disclosure:
Seraj Makkawi: nothing to disclose.
Dina Lavorato: nothing to disclose.
Jamie Greenfield: nothing to disclose.
Helene Parpal received funding from Teva, EMD Serono, Novartis, Genzyme and Biogen to attend different MS meetings, for consultant meetings or for talks, from 2012 to 2017.
Luanne Metz has received grant support from Hoffman La Roche.
Abstract: EP1355
Type: ePoster
Abstract Category: Clinical aspects of MS - 6 MS and gender
Background: The effect of pregnancy on long-term disability in women with relapsing-remitting multiple sclerosis (MS) is poorly understood.
Aim: To determine the association between delaying Disease Modifying Therapy (DMT) for pregnancy planning and long-term disability, as measured by the expanded disability status scale (EDSS), in women with relapsing-remitting MS.
Methods: Using data from the Calgary MS Clinic database, we identified 426 women with EDSS < 5, who delayed starting DMT for more than one year after it was recommended during the period 1999 to 2006. Thirty-seven consenting women declined DMT due to planned pregnancy. EDSS at diagnosis was compared with EDSS at 5, 7, 10 and 15 years. The association between the cumulative time on DMT during the first 5 years of MS and EDSS change at 5, 7, 10, and 15 years was determined. EDSS change was compared with EDSS change in a control group of 101 women with relapsing-remitting MS (diagnosed between 18-40 years) who declined DMT for other reasons.
Results: Mean follow-up after diagnosis was 14.05 years. Prior to the diagnosis of MS 86.5% were nulliparous compared with 19% at the end of follow-up. Mean time to pregnancy was 2.38 years from MS diagnosis and 0.84 years from declining DMT for pregnancy. Eventually, 67.6% of the patients started DMT. Mean time to initiating DMT was 4.02 years after declining DMT for pregnancy. Confirmed relapses occurred in 70.3% of women between declining DMT due to pregnancy and starting DMT; the mean time to a relapse was 1.92 years. There was an increase in the mean EDSS score 15 years after diagnosis of 1.13 points (paired t-test, p= 0.002) among women declined DMT for pregnancy planning. There was a moderate to high moderate negative correlation between the cumulative time on DMT during the first 5 years after the diagnosis of MS and EDSS change at 7 (R= -0.49, p=0.008), 10 (R= -0.44, p=0.017), and 15 (R= -0.67, p=0.006) years. When compared to the control group who delayed DMT for other reasons, change in EDSS at 5, 7, 10, and 15 years was not significant even after adjustment for age.
Conclusion: Delaying DMT initiation for a planned pregnancy did not have a major impact of disability over 15 years in our patients despite the frequent occurrence of relapses and statistically significant change in EDSS. Greater time on DMT during the first 5 years after their MS diagnosis was associated with a statistically significant reduction in EDSS change.
Disclosure:
Seraj Makkawi: nothing to disclose.
Dina Lavorato: nothing to disclose.
Jamie Greenfield: nothing to disclose.
Helene Parpal received funding from Teva, EMD Serono, Novartis, Genzyme and Biogen to attend different MS meetings, for consultant meetings or for talks, from 2012 to 2017.
Luanne Metz has received grant support from Hoffman La Roche.