Contributions
Abstract: 216
Type: Oral
Abstract Category: Clinical aspects of MS - 6 MS and gender
Background: Available evidence is not conclusive about the possible impact of hormonal factors on MS risk and prognosis in women with a CIS.
Objective: The aim of this study was to investigate the effect of oral contraceptive use and menopause on the risk of developing MS and disability accrual in women with a
Methods: A cross-sectional survey on reproductive information was conducted on women belonging to the Barcelona CIS prospective cohort. We studied the possible association between oral contraceptive (OC) use and menopause with age at CIS, time to second attack (CDMS), time to McDonald MS and time to confirmed Expanded Disability Expanded Status Scale (EDSS) 3.0. For each predictive variable, Cox proportional-hazards regression modelling adjusting age at onset, CIS topography, presence of oligoclonal bands (OB), MRI and disease modifying treatment (DMT) was used to estimate adjusted hazard ratios (aHR). DMT, OC use after CIS and menopause were included as time-dependent variables.
Results: 518 females (65% of the study population) completed the survey. CIS patients who started OC early in life (pre-CIS) had an older age at CIS (28.4 vs 32.7 years; p< 0.001). OC before CIS did not increase the risk of 2nd attack (aHR 1.2; 95% CI 0.9- 1.5) or MS according to McDonald (HR aHR 1.02; 95% CI 0.8- 1.3) compared to those who started OC after CIS or never used OC. OC use before CIS (aHR 1.3; 95% CI 0.8-2.2) or during the course of the disease (aHR 0.8 95% CI 0.5-1.3) did not show an impact on disability accrual. Women who reached menopause over follow-up (n=80) had a mean older age at disease onset (39.9 vs 29.7; p< 0.001) with no differences in the time to 2nd attack (32.3 vs 39.23; p=0.3). Menopause was associated with a non-significant increased risk of EDSS 3.0 (HR 1.34 95% CI 0.8-2.3) but this effect was lost in the multivariable analysis (aHR 1.06 95% CI 0.6-2.04) and when menopause was considered as a time-dependent variable (aHR 0.45 95% CI 0.2-1.4).
Conclusion: Early start of OC (pre-CIS) is associated with an older age at CIS, which is probably explained by the fact that the moment of starting OC is age-dependent. OC and menopause do not seem to have an impact on the risk of McDonald MS, second attack or disability acccrual, once adjusted for age and other confounders.
Disclosure: SOR has received compensation for consulting services from Biogen-Idec and Genzyme, and research support from Novartis.
GA has received compensation for consulting services from Biogen-Idec, research support from Novartis, and speaking honoraria from Sanofi-Aventis.
JSG has received compensation for participating on Advisory Boards, speaking honoraria and travel expenses for scientific meetings, consulting services or research support from Novartis, Biogen, Serono Symposia International Foundation, Merck, Almirall, and Genzyme.
XM has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Actelion, Amirall, Bayer, Biogen, Celgene, Genzyme, Hoffmann-La Roche, Novartis, Oryzon Genomics, Sanofi-Genzyme and Teva Pharmaceutical.
MT has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche.
Abstract: 216
Type: Oral
Abstract Category: Clinical aspects of MS - 6 MS and gender
Background: Available evidence is not conclusive about the possible impact of hormonal factors on MS risk and prognosis in women with a CIS.
Objective: The aim of this study was to investigate the effect of oral contraceptive use and menopause on the risk of developing MS and disability accrual in women with a
Methods: A cross-sectional survey on reproductive information was conducted on women belonging to the Barcelona CIS prospective cohort. We studied the possible association between oral contraceptive (OC) use and menopause with age at CIS, time to second attack (CDMS), time to McDonald MS and time to confirmed Expanded Disability Expanded Status Scale (EDSS) 3.0. For each predictive variable, Cox proportional-hazards regression modelling adjusting age at onset, CIS topography, presence of oligoclonal bands (OB), MRI and disease modifying treatment (DMT) was used to estimate adjusted hazard ratios (aHR). DMT, OC use after CIS and menopause were included as time-dependent variables.
Results: 518 females (65% of the study population) completed the survey. CIS patients who started OC early in life (pre-CIS) had an older age at CIS (28.4 vs 32.7 years; p< 0.001). OC before CIS did not increase the risk of 2nd attack (aHR 1.2; 95% CI 0.9- 1.5) or MS according to McDonald (HR aHR 1.02; 95% CI 0.8- 1.3) compared to those who started OC after CIS or never used OC. OC use before CIS (aHR 1.3; 95% CI 0.8-2.2) or during the course of the disease (aHR 0.8 95% CI 0.5-1.3) did not show an impact on disability accrual. Women who reached menopause over follow-up (n=80) had a mean older age at disease onset (39.9 vs 29.7; p< 0.001) with no differences in the time to 2nd attack (32.3 vs 39.23; p=0.3). Menopause was associated with a non-significant increased risk of EDSS 3.0 (HR 1.34 95% CI 0.8-2.3) but this effect was lost in the multivariable analysis (aHR 1.06 95% CI 0.6-2.04) and when menopause was considered as a time-dependent variable (aHR 0.45 95% CI 0.2-1.4).
Conclusion: Early start of OC (pre-CIS) is associated with an older age at CIS, which is probably explained by the fact that the moment of starting OC is age-dependent. OC and menopause do not seem to have an impact on the risk of McDonald MS, second attack or disability acccrual, once adjusted for age and other confounders.
Disclosure: SOR has received compensation for consulting services from Biogen-Idec and Genzyme, and research support from Novartis.
GA has received compensation for consulting services from Biogen-Idec, research support from Novartis, and speaking honoraria from Sanofi-Aventis.
JSG has received compensation for participating on Advisory Boards, speaking honoraria and travel expenses for scientific meetings, consulting services or research support from Novartis, Biogen, Serono Symposia International Foundation, Merck, Almirall, and Genzyme.
XM has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past with Actelion, Amirall, Bayer, Biogen, Celgene, Genzyme, Hoffmann-La Roche, Novartis, Oryzon Genomics, Sanofi-Genzyme and Teva Pharmaceutical.
MT has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck-Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Novartis, Almirall, Genzyme, and Roche.