Contributions
Abstract: P872
Type: Poster
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: Hormonal variations are known to influence the course of Multiple sclerosis (MS), accounting for fluctuations in disease activity through pregnancy and gender-specific prognosis. Yet, the impact of menopause in the disease course is unknown.
Methods: We conducted a retrospective study among women seen in our MS outpatient clinic. We only included women which had at least one assessment between the age of 45-55 (average age of menopause). Patients were asked to answer a telephone questionnaire concerning the timing and circumstances of menopause. Those patients with a diagnosis of MS at least 2 years before the menopause and minimal follow-up of 1 year after menopause were eligible to the analysis; We collected data of a period up to 5 years prior and after menopause. We performed a comparison between the rate of Expanded Disability Status Scale (EDSS) change, Annual Relapse Rate (ARR) and presence of new T2 lesions and gadolinium-enhancing lesions before and after menopause using Wilcoxon/sign or McNemar test.
Results: We evaluated 34 women, mean age 55,7 (± 6,0) with a mean disease duration of 17,8 (±7,6) years and a mean time of follow-up after menopause of 6,4 (±5,3) years. 73,5% (n= 25) had a diagnosis of relapsing-remitting MS, 20,6% (n=7) of secondary progressive MS and the remaining of primary progressive MS. Although the EDSS was higher after menopause comparing with the pre-menopausal period (3,4 vs 2,1 p< 0,001), the rate of EDSS change in both periods wasn't significantly different (0,13 vs 0,14, p= 0,93). 26 patients presented relapses during the observation period. We register an annual relapse rate 5 times higher in the pre-menopausal period vs post-menopausal (0,25 vs 0,05 p< 0,001). The presence of gadolinium-enhancing lesion and new lesion in T2 wasn't significantly different in both periods (p>0,05).
Conclusions: In our sample, only the ARR seemed to be influenced by the menopause, and the impact was favorable, with a decrease of the number of relapses. After menopause, the disability increase seemed comparable to the pre-menopausal period, however, the number of relapses was inferior, which might suggest a transition to a progressive course or an incomplete recovery after relapses.
The imagiologic parameters were stable through menopause, but only conventional measures were used. Further studies applying volumetric assessments would be useful to confirm if indeed imagiologic endpoints are not Influenced by menopause.
Disclosure:
Filipa Ladeira has received travel fees from Biogen,Teva, Genzyme and Merck Serono
Manuel Salaviza has received travel fees from Genzyme and Merck Serono.
A. S. Correia received an educational sponsorship from Merck Serono, consultant and speeking fees from Novartis, Biogen Idec and Merck, as well as research support from Biogen Idec and support for scientific meetings from Novartis, Biogen Idec, Sanofi Genzyme, Teva and Bayer.
Raquel Barbosa, André Caetano has no conflicts of interest
Abstract: P872
Type: Poster
Abstract Category: Clinical aspects of MS - 4 Natural course
Background: Hormonal variations are known to influence the course of Multiple sclerosis (MS), accounting for fluctuations in disease activity through pregnancy and gender-specific prognosis. Yet, the impact of menopause in the disease course is unknown.
Methods: We conducted a retrospective study among women seen in our MS outpatient clinic. We only included women which had at least one assessment between the age of 45-55 (average age of menopause). Patients were asked to answer a telephone questionnaire concerning the timing and circumstances of menopause. Those patients with a diagnosis of MS at least 2 years before the menopause and minimal follow-up of 1 year after menopause were eligible to the analysis; We collected data of a period up to 5 years prior and after menopause. We performed a comparison between the rate of Expanded Disability Status Scale (EDSS) change, Annual Relapse Rate (ARR) and presence of new T2 lesions and gadolinium-enhancing lesions before and after menopause using Wilcoxon/sign or McNemar test.
Results: We evaluated 34 women, mean age 55,7 (± 6,0) with a mean disease duration of 17,8 (±7,6) years and a mean time of follow-up after menopause of 6,4 (±5,3) years. 73,5% (n= 25) had a diagnosis of relapsing-remitting MS, 20,6% (n=7) of secondary progressive MS and the remaining of primary progressive MS. Although the EDSS was higher after menopause comparing with the pre-menopausal period (3,4 vs 2,1 p< 0,001), the rate of EDSS change in both periods wasn't significantly different (0,13 vs 0,14, p= 0,93). 26 patients presented relapses during the observation period. We register an annual relapse rate 5 times higher in the pre-menopausal period vs post-menopausal (0,25 vs 0,05 p< 0,001). The presence of gadolinium-enhancing lesion and new lesion in T2 wasn't significantly different in both periods (p>0,05).
Conclusions: In our sample, only the ARR seemed to be influenced by the menopause, and the impact was favorable, with a decrease of the number of relapses. After menopause, the disability increase seemed comparable to the pre-menopausal period, however, the number of relapses was inferior, which might suggest a transition to a progressive course or an incomplete recovery after relapses.
The imagiologic parameters were stable through menopause, but only conventional measures were used. Further studies applying volumetric assessments would be useful to confirm if indeed imagiologic endpoints are not Influenced by menopause.
Disclosure:
Filipa Ladeira has received travel fees from Biogen,Teva, Genzyme and Merck Serono
Manuel Salaviza has received travel fees from Genzyme and Merck Serono.
A. S. Correia received an educational sponsorship from Merck Serono, consultant and speeking fees from Novartis, Biogen Idec and Merck, as well as research support from Biogen Idec and support for scientific meetings from Novartis, Biogen Idec, Sanofi Genzyme, Teva and Bayer.
Raquel Barbosa, André Caetano has no conflicts of interest