Contributions
Abstract: P889
Type: Poster
Abstract Category: Clinical aspects of MS - 6 MS and gender
Introduction: Few studies have addressed the effect of menopause (MP) on multiple sclerosis (MS): some have shown a worsening of subjective symptoms after MP1, 2, one found a higher disability accumulation after MP3.
Objective: to define the impact of natural MP on MS course.
Methods: we included consecutive women with MS and a natural MP onset after 2005. Exclusion criteria: MS onset < 3 years pre-MP, primary progressive MS, date of MP uncertain, previous use of cyclophosphamide/mitoxantrone, hysterectomy/endometrial ablation, neoplasm/HIV, use of hormonal replacement therapy (HRT) < 3 years pre-MP.
Main outcomes were comparisons of ARR and EDSS score variation pre Vs post-MP. Sensitivity analyses (SAs) were performed excluding: patients with secondary progressive (SP) MS, artificial insemination (AI), second-line drugs (natalizumab/fingolimod) suspension, discontinuous therapy (i.e. therapy started after first observation or permanently suspended before last observation, washout between different drugs >6 months), only use of second-line drugs.
Multivariate analyses were done to determine if cigarette smoking, nulliparity and HRT post-MP could influence the disease course (adjusting for age at MP, MS duration, MS centre).
Results: we included 84 patients from 10 centres (age at MP: 50.2±3.2 years, MS duration: 14.6±7.8 years). SPMS patients were 4 (5%). Observation period was about 3.5 years pre/post-MP. Cigarette smokers were 27 (32%), nulliparous were 21 (25%), 4 received HRT post-MP, none underwent to AI. At MP median EDSS score was 2.0. The majority (93%) received DMTs during observation: 59 (73%) only first-line drugs (interferons, glatiramer acetate, dymethilfumarate, teriflunomide), 2 only second-line drugs, 15 (18%) first and second-line drugs. Therapy was discontinuous for 38 (45%) patients.
We observed a significant reduction in ARR after MP (0.13±0.23 Vs 0.23±0.28, p=0.009), confirmed in all SAs. Worsening of EDSS pre/post-MP was not significantly different in all patient analysis, but resulted significantly higher post-MP after exclusion of patients with discontinuous therapy (p=0.038). Multivariate analyses did not find any influence of cigarette smoking, nulliparity and HRT on disease course during MP.
Conclusion: ARR is significantly reduced after natural MP. On the other hand EDSS score could increase faster after natural MP, as previously shown3. These findings should be confirmed in studies with higher sample size.
Disclosure: Damiano Baroncini acted as an Advisory Board member of Sanofi-Genzyme, received funding for traveling and honoraria for speaking or writing from Novartis, Teva, Genzyme, Merk-Serono and Almirall. She received support for editorial project by Almirall.
Giulia Mallucci received support to travel to scientific meetings from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis, Teva; received speaker honoraria from Biogen Idec and served on the scientific advisory board for Genzyme and Merck Serono.
Valentina Torri Clerici acted as an Advisory Board member of Novartis and Merck-Serono, received funding for traveling and honoraria for speaking or writing from Teva, Biogen, Genzyme, Merk-Serono and Almirall. She received support for research project by Almirall.
Silvia Rossi acted as an Advisory Board member of Biogen Idec, Bayer Schering, Merck Serono, Teva, Novartis and Genzyme, and received funding for traveling and honoraria for consultancy, speaking or writing from Biogen Idec, Merck Serono, Teva, Novartis, Bayer Schering, Genzyme, Almirall. She received support for research project by Teva, Merck Serono and Bayer Schering and is involved as principal investigator in clinical trials for Teva, Novartis and Roche.
Maria Josè Messina received funding for traveling and honoraria for speaking or writing from Genzyme.
Caterina Barrilà received honoraria for speaking from Serono.
Marco Ronzoni has received consulting fees from Merck Serono and congress support from Biogen Idec, Sanofi-Genzyme, Novartis, Merck Serono, Teva Pharmaceuticals.
Pietro Annovazzi received honoraria for lecturing and participation in advisory boards, and/or travel expenses for attending congresses and meetings from Merck, Biogen, Teva, Sanofi-Genzyme, Almirall, Roche and Novartis.
Valeria Barcella, Emanuela Susani, Maria Letizia Fusco and Luca Chiveri have nothing to disclose.
Abstract: P889
Type: Poster
Abstract Category: Clinical aspects of MS - 6 MS and gender
Introduction: Few studies have addressed the effect of menopause (MP) on multiple sclerosis (MS): some have shown a worsening of subjective symptoms after MP1, 2, one found a higher disability accumulation after MP3.
Objective: to define the impact of natural MP on MS course.
Methods: we included consecutive women with MS and a natural MP onset after 2005. Exclusion criteria: MS onset < 3 years pre-MP, primary progressive MS, date of MP uncertain, previous use of cyclophosphamide/mitoxantrone, hysterectomy/endometrial ablation, neoplasm/HIV, use of hormonal replacement therapy (HRT) < 3 years pre-MP.
Main outcomes were comparisons of ARR and EDSS score variation pre Vs post-MP. Sensitivity analyses (SAs) were performed excluding: patients with secondary progressive (SP) MS, artificial insemination (AI), second-line drugs (natalizumab/fingolimod) suspension, discontinuous therapy (i.e. therapy started after first observation or permanently suspended before last observation, washout between different drugs >6 months), only use of second-line drugs.
Multivariate analyses were done to determine if cigarette smoking, nulliparity and HRT post-MP could influence the disease course (adjusting for age at MP, MS duration, MS centre).
Results: we included 84 patients from 10 centres (age at MP: 50.2±3.2 years, MS duration: 14.6±7.8 years). SPMS patients were 4 (5%). Observation period was about 3.5 years pre/post-MP. Cigarette smokers were 27 (32%), nulliparous were 21 (25%), 4 received HRT post-MP, none underwent to AI. At MP median EDSS score was 2.0. The majority (93%) received DMTs during observation: 59 (73%) only first-line drugs (interferons, glatiramer acetate, dymethilfumarate, teriflunomide), 2 only second-line drugs, 15 (18%) first and second-line drugs. Therapy was discontinuous for 38 (45%) patients.
We observed a significant reduction in ARR after MP (0.13±0.23 Vs 0.23±0.28, p=0.009), confirmed in all SAs. Worsening of EDSS pre/post-MP was not significantly different in all patient analysis, but resulted significantly higher post-MP after exclusion of patients with discontinuous therapy (p=0.038). Multivariate analyses did not find any influence of cigarette smoking, nulliparity and HRT on disease course during MP.
Conclusion: ARR is significantly reduced after natural MP. On the other hand EDSS score could increase faster after natural MP, as previously shown3. These findings should be confirmed in studies with higher sample size.
Disclosure: Damiano Baroncini acted as an Advisory Board member of Sanofi-Genzyme, received funding for traveling and honoraria for speaking or writing from Novartis, Teva, Genzyme, Merk-Serono and Almirall. She received support for editorial project by Almirall.
Giulia Mallucci received support to travel to scientific meetings from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis, Teva; received speaker honoraria from Biogen Idec and served on the scientific advisory board for Genzyme and Merck Serono.
Valentina Torri Clerici acted as an Advisory Board member of Novartis and Merck-Serono, received funding for traveling and honoraria for speaking or writing from Teva, Biogen, Genzyme, Merk-Serono and Almirall. She received support for research project by Almirall.
Silvia Rossi acted as an Advisory Board member of Biogen Idec, Bayer Schering, Merck Serono, Teva, Novartis and Genzyme, and received funding for traveling and honoraria for consultancy, speaking or writing from Biogen Idec, Merck Serono, Teva, Novartis, Bayer Schering, Genzyme, Almirall. She received support for research project by Teva, Merck Serono and Bayer Schering and is involved as principal investigator in clinical trials for Teva, Novartis and Roche.
Maria Josè Messina received funding for traveling and honoraria for speaking or writing from Genzyme.
Caterina Barrilà received honoraria for speaking from Serono.
Marco Ronzoni has received consulting fees from Merck Serono and congress support from Biogen Idec, Sanofi-Genzyme, Novartis, Merck Serono, Teva Pharmaceuticals.
Pietro Annovazzi received honoraria for lecturing and participation in advisory boards, and/or travel expenses for attending congresses and meetings from Merck, Biogen, Teva, Sanofi-Genzyme, Almirall, Roche and Novartis.
Valeria Barcella, Emanuela Susani, Maria Letizia Fusco and Luca Chiveri have nothing to disclose.