Contributions
Abstract: P369
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS and gender
Introduction: it is still not clear what happens to women with multiple sclerosis (MS) during menopausal transition: some studies have shown a worsening of subjective symptoms after menopause (MP)1, 2, while one found a higher disability accumulation after MP3.
Objective: Last year we presented data on 84 patients, now we present data of a larger population.
Methods: we included 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. The observation period was set at 2-4 years pre and post-MP. Main outcomes were comparisons of ARR and EDSS scores pre/post-MP (ANOVA repeated measures). Possible confounders included in the analyses were: age at MP, MS duration, cigarette smoking, nulliparity and HRT post-MP. The analyses were repeated excluding women who suspended natalizumab (NAT) or fingolimod (FTY) during observation (confounder effect due to iatrogenic disease reactivation/rebound).
Results: we included 148 women from 16 centres in Italy (age at MP: 50.3±3.8 years, MS duration: 14.9±8.1 years). Observation period was about 3.5 years pre/post-MP. Cigarette smokers were 43 (29%), nulliparous were 39 (26%), 5 received HRT post-MP. At MP median EDSS score was 2.0. The majority of patients (93%) received DMTs during the observational period: 101 (68%) only first-line drugs (IFNs, glatiramer acetate, dimethyl fumarate, teriflunomide), 4 only second-line drugs (FTY, NAT, alemtuzumab), 31 (21%) both types of drugs. Most of subjects (78%) started DMTs before MP (6.6±3.9 years pre-MP). Twelve patients suspended NAT/FTY treatment during observation. ARR significantly reduced after MP with respect to pre-MP period (0.13±0.24 Vs 0.22±0.31, p=0.002). EDSS score increased significantly during the whole observation (p< 0.001), but the main differences were found after MP (p< 0.001), especially after excluding women with NAT/FTY interruption (EDSS score increased of 0.27 points and 0.46 points 2 and 4 years after MP). No interactions were found adjusting for possible confounders.
Conclusion: after MP ARR significantly decreases, while disability significantly increases. These results are in agreement with our previous work and literature3. Natural MP could be a turning point to a less inflammatory, progressive phase of disease.
Disclosure: Damiano Baroncini received travel grants from Genzyme, Merck and Biogen for participation at national and international congresses; he received speaking honoraria from Sanofi and Novartis, and personal compensation from Almirall for scientific publication.
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, Mylan, Almirall, Roche and Novartis.
Nicola De Rossi received speaker honoraria from Biogen Idec, Genzyme, Novartis, Sanofi-Aventis; received funding for participation in advisory board to Novartis and Genzyme-Sanofi and for travel to scientific meetings from Biogen Idec, teva, Sanofi-Genzyme, Roche, Almirall and Novartis
Giulia Mallucci received support to travel to scientific meetings from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Roche, Sanofi-Aventis, Teva; received speaker honoraria from Biogen Idec and served on the scientific advisory board for Biogen, 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.
Simone Tonietti received honoraria for lecturing from Teva and Sanofi-Genzime, for writing from Teva, for participation in advisory boards from Merck and Biogen and for travel expenses for attending congresses and meetings from Merck, Biogen, Teva, Sanofi-Genzyme and Novartis.
Maria Josè Messina received funding for traveling and honoraria for speaking or writing from Genzyme.
Marco Ronzoni received travel grants for congresses participation from Biogen, Genzyme, Novartis e Merck. He received honoraria for conferences organization from Biogen. He received honoraria from Merck, Novartis, Biogen for advisory boards participation.
Valeria Barcella received speaking honoraria and/or consultant fees from Biogen Idec, Merck Serono, Bayer, Sanofi- Genzyme, Novartis.
Vittorio Mantero received honoraria for participation to advisory boards and/or travel expenses for attending congresses and meetings from Merck, Biogen, Teva, Sanofi-Genzyme, Roche and Novartis.
Paolo Confalonieri has been a board member of Biogen Idec, received travel grants from Sanofi, Biogen and Merck Serono.
Ruggero Capra has received consulting fees from Biogen, Teva, Genzyme, Merck Serono, and Novartis.
Mauro Zaffaroni has received honoraria for lecturing or participation in advisory boards, and financial support for attending congresses from Almirall, Biogen Idec, Genzyme, Merck Serono, Novartis, and Teva.
Emanuela Susani, Maria Letizia Fusco, Caterina Barrilà, Luca Chiveri, Loredana La Mantia, Maria Teresa Ferrò, Raffaella Clerici, Ottavia Ferraro, Elena Colombo and Lucia Abate have nothing to disclose.
Abstract: P369
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS and gender
Introduction: it is still not clear what happens to women with multiple sclerosis (MS) during menopausal transition: some studies have shown a worsening of subjective symptoms after menopause (MP)1, 2, while one found a higher disability accumulation after MP3.
Objective: Last year we presented data on 84 patients, now we present data of a larger population.
Methods: we included 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. The observation period was set at 2-4 years pre and post-MP. Main outcomes were comparisons of ARR and EDSS scores pre/post-MP (ANOVA repeated measures). Possible confounders included in the analyses were: age at MP, MS duration, cigarette smoking, nulliparity and HRT post-MP. The analyses were repeated excluding women who suspended natalizumab (NAT) or fingolimod (FTY) during observation (confounder effect due to iatrogenic disease reactivation/rebound).
Results: we included 148 women from 16 centres in Italy (age at MP: 50.3±3.8 years, MS duration: 14.9±8.1 years). Observation period was about 3.5 years pre/post-MP. Cigarette smokers were 43 (29%), nulliparous were 39 (26%), 5 received HRT post-MP. At MP median EDSS score was 2.0. The majority of patients (93%) received DMTs during the observational period: 101 (68%) only first-line drugs (IFNs, glatiramer acetate, dimethyl fumarate, teriflunomide), 4 only second-line drugs (FTY, NAT, alemtuzumab), 31 (21%) both types of drugs. Most of subjects (78%) started DMTs before MP (6.6±3.9 years pre-MP). Twelve patients suspended NAT/FTY treatment during observation. ARR significantly reduced after MP with respect to pre-MP period (0.13±0.24 Vs 0.22±0.31, p=0.002). EDSS score increased significantly during the whole observation (p< 0.001), but the main differences were found after MP (p< 0.001), especially after excluding women with NAT/FTY interruption (EDSS score increased of 0.27 points and 0.46 points 2 and 4 years after MP). No interactions were found adjusting for possible confounders.
Conclusion: after MP ARR significantly decreases, while disability significantly increases. These results are in agreement with our previous work and literature3. Natural MP could be a turning point to a less inflammatory, progressive phase of disease.
Disclosure: Damiano Baroncini received travel grants from Genzyme, Merck and Biogen for participation at national and international congresses; he received speaking honoraria from Sanofi and Novartis, and personal compensation from Almirall for scientific publication.
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, Mylan, Almirall, Roche and Novartis.
Nicola De Rossi received speaker honoraria from Biogen Idec, Genzyme, Novartis, Sanofi-Aventis; received funding for participation in advisory board to Novartis and Genzyme-Sanofi and for travel to scientific meetings from Biogen Idec, teva, Sanofi-Genzyme, Roche, Almirall and Novartis
Giulia Mallucci received support to travel to scientific meetings from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Roche, Sanofi-Aventis, Teva; received speaker honoraria from Biogen Idec and served on the scientific advisory board for Biogen, 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.
Simone Tonietti received honoraria for lecturing from Teva and Sanofi-Genzime, for writing from Teva, for participation in advisory boards from Merck and Biogen and for travel expenses for attending congresses and meetings from Merck, Biogen, Teva, Sanofi-Genzyme and Novartis.
Maria Josè Messina received funding for traveling and honoraria for speaking or writing from Genzyme.
Marco Ronzoni received travel grants for congresses participation from Biogen, Genzyme, Novartis e Merck. He received honoraria for conferences organization from Biogen. He received honoraria from Merck, Novartis, Biogen for advisory boards participation.
Valeria Barcella received speaking honoraria and/or consultant fees from Biogen Idec, Merck Serono, Bayer, Sanofi- Genzyme, Novartis.
Vittorio Mantero received honoraria for participation to advisory boards and/or travel expenses for attending congresses and meetings from Merck, Biogen, Teva, Sanofi-Genzyme, Roche and Novartis.
Paolo Confalonieri has been a board member of Biogen Idec, received travel grants from Sanofi, Biogen and Merck Serono.
Ruggero Capra has received consulting fees from Biogen, Teva, Genzyme, Merck Serono, and Novartis.
Mauro Zaffaroni has received honoraria for lecturing or participation in advisory boards, and financial support for attending congresses from Almirall, Biogen Idec, Genzyme, Merck Serono, Novartis, and Teva.
Emanuela Susani, Maria Letizia Fusco, Caterina Barrilà, Luca Chiveri, Loredana La Mantia, Maria Teresa Ferrò, Raffaella Clerici, Ottavia Ferraro, Elena Colombo and Lucia Abate have nothing to disclose.