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Van Neste M, Nauwelaerts N, Ceulemans M, Cuppers B, Annaert P, Smits A, Allegaert K. Very low monomethyl fumarate exposure via human milk: a case report-a contribution from the ConcePTION project. Front Public Health 2024; 12:1393752. [PMID: 39015385 PMCID: PMC11250615 DOI: 10.3389/fpubh.2024.1393752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/14/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction While breastfeeding is recommended, knowledge regarding medicine transfer to human milk and its safety for nursing infants is limited. Only one paper has previously described dimethyl fumarate (DMF) transfer during breastfeeding in two patients at 5 and 6 months postpartum, respectively. The current case report describes maternal pharmacokinetic data of monomethyl fumarate (MMF), the active metabolite of DMF, and infant exposure estimations of MMF at 3 months postpartum. Methods A 32-year-old Caucasian woman started DMF therapy (120 mg, 2x/day) for multiple sclerosis at 3 months postpartum, after weaning her infant from breastfeeding. On day 99 after birth, the patient collected four milk samples over 24 h after 6 days of treatment at the initial dose. Additionally, a single maternal blood sample was collected to calculate the milk-to-plasma (M/P) ratio. The samples were analyzed using liquid chromatography coupled with the mass spectrometry method. Results A wide range of measured steady-state concentrations of MMF (5.5-83.5 ng/mL) was observed in human milk samples. Estimated daily infant dosage values for MMF, calculated with 150 and 200 mL/kg/day human milk intake, were 5.76 and 7.68 μg/kg/day, and the relative infant doses were 0.16 and 0.22%. The observed mean M/P ratio was 0.059, similar to the M/P ratio predicted using the empirical Koshimichi model (0.06). Discussion Combining this case report with the two previously described cases, the estimated infant exposure is low, albeit with relevant intra- and inter-patient variabilities. Research should further focus on infant exposure and safety.
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Affiliation(s)
- Martje Van Neste
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
| | - Nina Nauwelaerts
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- Teratology Information Service, Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, Netherlands
| | - Benedikte Cuppers
- Teratology Information Service, Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, Netherlands
| | - Pieter Annaert
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- BioNotus GCV, Niel, Belgium
| | - Anne Smits
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Karel Allegaert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Child & Youth Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
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Cuello JP, Meldaña Rivera A, Monreal E, Gómez Lozano A, García Cano AM, García Domínguez JM, Fernández Velasco JI, Costa-Frossard França L, Goicochea H, Higueras Y, De León-Luis JA, Sainz De La Maza S, Villarrubia N, Arribas Gómez I, Ruiz Perez I, Martinez Ginés ML, Villar LM. Emerging biomarkers for improving pregnancy planning in multiple sclerosis. Front Neurol 2024; 15:1292296. [PMID: 38426179 PMCID: PMC10902912 DOI: 10.3389/fneur.2024.1292296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Background Patient disability, relapse rate, and age are used for family planning in multiple sclerosis (MS). However, the need for more accurate biomarkers is widely recognized. We aimed to explore the influence of age on neurofilament light chain (sNfL), which reflects acute inflammation; glial fibrillary acidic protein (GFAP), associated with disability progression independent of relapses; and anti-Müllerian hormone (AMH), reflecting ovarian reserve, to provide a tailored family planning strategy. Methods This case-control study included 95 MS patients and 61 healthy control women (HCW). sNfL and GFAP levels were measured using a sensitive single-molecule array assay. AMH levels were measured by the automated Elecsys® Anti-Müllerian Hormone Assay. Results We observed no significant differences in AMH values between MS patients and the control group within any of the age-matched categories. Age exhibited a negative correlation with AMH values in both groups, as expected. Nevertheless, our findings suggest a slight tendency toward reduced ovarian reserve in MS patients (rho MS patients = -0.67, p < 0.0001; rho HCW = -0.43, p = 0.0006). Interestingly, among the 76 MS participants under 40 years old, we identified ten individuals (13.1%) with AMH levels below 0.7 ng/ml, indicative of a low ovarian reserve, and an additional six individuals (7.8%) with AMH levels between 0.7 ng/ml and 0.9 ng/ml, suggesting a potential risk of premature ovarian failure. Conversely, sNfL and GFAP levels in the MS group exhibited high variability but showed no significant association with age intervals. Conclusion We found no significant differences in AMH, sNfL or GFAP values between MS patients and the control group within any of the age-matched categories. The assessment of AMH, sNFL and GFAP levels at MS onset facilitates personalized therapeutic and family planning strategies for childbearing-age women.
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Affiliation(s)
- Juan Pablo Cuello
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Ana Gómez Lozano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Maria García Cano
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - José Ignacio Fernández Velasco
- Department of Immunology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Lucienne Costa-Frossard França
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Haydee Goicochea
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan Antonio De León-Luis
- Health Research Institute Gregorio Marañón, Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Susana Sainz De La Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Noelia Villarrubia
- Department of Immunology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Ignacio Arribas Gómez
- Department of Clinical Biochemistry, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Irene Ruiz Perez
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Red Española de Esclerosis Múltiple (REEM), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
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Swital M, Drouin J, Miranda S, Bakchine S, Botton J, Dray-Spira R. Use of multiple sclerosis disease-modifying therapies during pregnancy in France: Nationwide study between 2010 and 2021. Mult Scler 2024; 30:227-237. [PMID: 38281078 PMCID: PMC10851628 DOI: 10.1177/13524585231223395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently affects women of childbearing age and pregnant women. OBJECTIVE To assess the use of MS disease-modifying therapies (DMTs) during pregnancy in France over the last decade, marked by an increasing DMTs availability. METHODS All pregnancies ended from April 2010 to December 2021 in women with MS were identified based on the nationwide Mother-Child Register EPI-MERES, built from the French National Health Data System (Système National des Données de Santé (SNDS)). RESULTS Of a total of 20,567 pregnancies in women with MS, 7587 were exposed to DMT. The number of DMT-exposed pregnancies markedly increased from 1079 in 2010-2012 to 2413 in 2019-2021 (+124%), especially those exposed to glatiramer acetate, natalizumab, dimethyl fumarate, and anti-CD20. Among pregnancies of women on DMT 6 months before pregnancy, 78.0% underwent DMT discontinuation and 7.6% switched DMT, generally before (33.0% and 77.0%, respectively) or during the first trimester of pregnancy (58.3% and 17.8%, respectively). DMT discontinuation decreased from 84.0% in 2010-2012 to 72.4% in 2019-2021 and was less frequent among women aged ⩾35 years and those socioeconomically disadvantaged. CONCLUSION Despite MS therapeutic management adaptations to pregnancy, exposure during pregnancy to treatments whose safety profile has not yet been clearly established has increased sharply over the last decade.
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Affiliation(s)
- Morgane Swital
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
- French National Institute of Health and Medical Research (INSERM), Department of Social Epidemiology (ERES), Pierre Louis Institute for Epidemiology and Public Health (IPLESP), Paris, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
| | - Sara Miranda
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
| | - Serge Bakchine
- University of Reims Champagne Ardennes (URCA), Reims, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
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Oreja-Guevara C, Tintoré M, Meca V, Prieto JM, Meca J, Mendibe M, Rodríguez-Antigüedad A. Family Planning in Fertile-Age Patients With Multiple Sclerosis (MS) (ConPlanEM Study): Delphi Consensus Statements. Cureus 2023; 15:e44056. [PMID: 37746391 PMCID: PMC10517726 DOI: 10.7759/cureus.44056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Family planning is essential for establishing Multiple Sclerosis (MS) prognosis, treatment decision, and disease monitoring. We aimed to generate an expert consensus addressing recommendations for family planning in MS patients of childbearing age. Initially, a committee comprising seven neurologists, experts in the MS field, identified the topics to be addressed. Then, the committee elaborated on different evidence-based preliminary statements. Next, using the Delphi methodology, a panel of neurologists manifested their level of agreement on the different statements using a Likert-type scale. Consensus was reached when ⩾70% of respondents expressed an agreement or disagreement using a five-point scale. Consensus was achieved on 47 out of 63 recommendations after three rounds of evaluations. The panel considered it essential to address family planning in all patients of childbearing age. There was also consensus that treatment should not be delayed due to the patient's desire for pregnancy. Additionally, in highly active patients, planning the pregnancy in the medium to long term using depletory drugs such as cladribine or alemtuzumab might represent a useful strategy. However, risks of adverse effects on the fetus due to drug-associated secondary autoimmunity should be addressed when alemtuzumab is considered. Moreover, the maintenance of natalizumab during pregnancy in very active patients reached expert consensus. Also, the panel supported the use of certain disease-modifying treatment (DMT) during lactation in selected cases. Our results identified specific areas of pregnancy planning in MS patients, where different treatment strategies might be considered to facilitate a safe and successful pregnancy while maintaining clinical and radiological stability.
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Affiliation(s)
| | - Mar Tintoré
- Neurology, Multiple Sclerosis Center of Catalonia (Cemcat) Vall d'Hebrón University Hospital, Barcelona, ESP
| | - Virginia Meca
- Neurology, Princess University Hospital, Madrid, ESP
| | - José María Prieto
- Neurology, University Clinical Hospital of Santiago de Compostela, Madrid, ESP
| | - José Meca
- Neurology, Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Virgen de la Arrixaca Clinical University Hospital, Cartagena, ESP
| | - Mar Mendibe
- Neurology, Neuroimmunology Group, Biocruces Bizkaia Research Institute, Cruces University Hospital, Bizkaia, ESP
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Zettl UK, Rommer PS, Aktas O, Wagner T, Richter J, Oschmann P, Cepek L, Elias-Hamp B, Gehring K, Chan A, Hecker M. Interferon beta-1a sc at 25 years: a mainstay in the treatment of multiple sclerosis over the period of one generation. Expert Rev Clin Immunol 2023; 19:1343-1359. [PMID: 37694381 DOI: 10.1080/1744666x.2023.2248391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Interferon beta (IFN beta) preparations are an established group of drugs used for immunomodulation in patients with multiple sclerosis (MS). Subcutaneously (sc) applied interferon beta-1a (IFN beta-1a sc) has been in continuous clinical use for 25 years as a disease-modifying treatment. AREAS COVERED Based on data published since 2018, we discuss recent insights from analyses of the pivotal trial PRISMS and its long-term extension as well as from newer randomized studies with IFN beta-1a sc as the reference treatment, the use of IFN beta-1a sc across the patient life span and as a bridging therapy, recent data regarding the mechanisms of action, and potential benefits of IFN beta-1a sc regarding vaccine responses. EXPERT OPINION IFN beta-1a sc paved the way to effective immunomodulatory treatment of MS, enabled meaningful insights into the disease process, and remains a valid therapeutic option in selected vulnerable MS patient groups.
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Affiliation(s)
- Uwe Klaus Zettl
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Paulus Stefan Rommer
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | | - Andrew Chan
- Department of Neurology, Inselspital Bern, University Hospital Bern, Bern, Switzerland
| | - Michael Hecker
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Mainguy M, Le Page E, Michel L, Leray E. Pregnancy-related healthcare utilization among women with multiple sclerosis. Front Neurol 2023; 14:1129117. [PMID: 36873453 PMCID: PMC9978388 DOI: 10.3389/fneur.2023.1129117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Many studies have investigated pregnancy in women with multiple sclerosis (MS). However, no study has measured prenatal healthcare utilization in women with MS or adherence to follow-up recommendations to improve antenatal care quality. A better knowledge of the quality of antenatal care in women with MS would help identify and better support women with insufficient follow-up. Our objective was to measure the level of compliance to prenatal care recommendations in women with MS using data from the French National Health Insurance Database. Methods This retrospective cohort study included all pregnant women with MS who gave live birth in France between 2010 and 2015. Using the French National Health Insurance Database, follow-up visits with gynecologists, midwives, and general practitioners (GPs) were identified, as well as ultrasound exams and laboratory tests. Based on the Adequacy of Prenatal Care Use and Content and Timing of care in Pregnancy indices, a new tool adapted to the French recommendations was developed to measure and classify the antenatal care trajectory (adequate or inadequate). Explicative factors were identified using multivariate logistic regression models. A random effect was included because women may have had more than one pregnancy during the study period. Results In total, 4,804 women with MS (N = 5,448 pregnancies ending in live births) were included. When considering only visits with gynecologists/midwives, 2,277 pregnancies (41.8%) were considered adequate. When adding visits with GP, their number increased to 3,646 (66.9%). Multivariate models showed that multiple pregnancy and higher medical density were associated with better adherence to follow-up recommendations. Conversely, adherence was lower in 25-29-year-old and >40-year-old women, in women with very low income, and agricultural and self-employed workers. No visits, ultrasound exams, and laboratory tests were recorded in 87 pregnancies (1.6%). In 50% of pregnancies, women had at least one visit with a neurologist during the pregnancy, and women restarted disease-modifying therapy (DMT) within 6 months after delivery in 45.9% of pregnancies. Discussion Many women consulted their GP during pregnancy. This could be linked to a low density of gynecologists but may also reflect the preferences of women. Our findings can help adapt recommendations and healthcare providers' practices according to the women's profiles.
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Affiliation(s)
- Marie Mainguy
- Univ Rennes, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, F-35000 Rennes, France
| | - Emmanuelle Le Page
- Neurology Department CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Rennes University Hospital Rennes University INSERM, Rennes, France
| | - Laure Michel
- Neurology Department CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Rennes University Hospital Rennes University INSERM, Rennes, France
| | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, F-35000 Rennes, France
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Haker MC, Frahm N, Hecker M, Langhorst SE, Mashhadiakbar P, Debus JL, Streckenbach B, Baldt J, Heidler F, Zettl UK. Therapy of women with multiple sclerosis: an analysis of the use of drugs that may have adverse effects on the unborn child in the event of (unplanned) pregnancy. Ther Adv Drug Saf 2023; 14:20420986221143830. [PMID: 37007872 PMCID: PMC10060274 DOI: 10.1177/20420986221143830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/21/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Although effective contraception is strongly recommended during the therapy of women with multiple sclerosis (MS) with some immunomodulatory drugs, unplanned pregnancies still occur. Adequate medication management is essential to avoid foetal harm in the event of an unplanned pregnancy. Objective: The aim was to screen for medications used in women of childbearing age with MS that may pose a risk of side effects on foetal development. Methods: Sociodemographic, clinical and medication data were collected from 212 women with MS by structured interviews, clinical examinations and medical records. Using the databases from Embryotox, Reprotox, the Therapeutic Goods Administration and on the German summaries of product characteristics, we assessed whether the taken drugs were potentially harmful regarding the foetal development. Results: The majority of patients (93.4%) were taking one or more drugs for which a possible harmful effect on the foetus is indicated in at least one of the four databases used. This proportion was even higher in patients who used hormonal contraceptives (birth control pills or vaginal rings) (PwCo, n = 101), but it was also quite high in patients who did not use such contraceptives (Pw/oCo, n = 111) (98.0% and 89.2%, respectively). PwCo were significantly more likely to take five or more medications with potential foetal risk according to at least one database than Pw/oCo (31.7% versus 6.3%). PwCo were also more severely disabled (average Expanded Disability Status Scale score: 2.8 versus 2.3) and more frequently had comorbidities (68.3% versus 54.1%) than Pw/oCo. Conclusion: Data on the most commonly used drugs in MS therapy were gathered to study the risk of possible drug effects on foetal development in female MS patients of childbearing age. We found that the majority of drugs used by patients with MS are rated as having a potential risk of interfering with normal foetal development. More effective contraception and special pregnancy information programmes regarding the therapy management during pregnancy should be implemented to reduce potential risks to mother and child. Plain Language Summary Use of drugs not recommended during pregnancy by women with multiple sclerosis Introduction: Patients with multiple sclerosis (MS) often have to take different drugs simultaneously. During the therapy with some immunomodulatory drugs, effective contraception is strongly recommended. Nevertheless, unplanned pregnancies occur regularly in women with MS. Methods: Here, we investigated whether the 212 patients included in this study were taking drugs with known possibility of harm to the development of an unborn child. This was done using four different drug databases. Results: A subset of 111 patients was not taking hormonal contraceptives (birth control pills or vaginal rings). Of those, 99 patients were taking at least one drug that is not recommended during pregnancy according to at least one of the four databases. Most of the medications taken have the potential to affect normal foetal development. Conclusion: To ensure safe use of medications, the patients should be reminded of the importance of effective contraception.
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Affiliation(s)
- Marie-Celine Haker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Jane Louisa Debus
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Felicita Heidler
- Department of Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Siracusano M, Carloni E, Riccioni A, Ferrara M, Scoppola C, Arturi L, Niolu C, Marfia GA, Mazzone L. Maternal Multiple Sclerosis and Offspring's Cognitive and Behavioral Development: What Do We Know until Now? CHILDREN (BASEL, SWITZERLAND) 2022; 9:1716. [PMID: 36360444 PMCID: PMC9689039 DOI: 10.3390/children9111716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/26/2023]
Abstract
Multiple Sclerosis (MS) is a chronic pathological condition representing one of the main causes of neurological disability in the female young population. MS, as an immune disorder, could impact fetus development, and, considering the need for and the possibility of pharmacological treatment during pregnancy, the possible influence of medication on developmental trajectories represents a topic of great interest. We provide an overview of the available literature on the influence of maternal Multiple Sclerosis on offspring cognitive and behavioral development. A study was conducted on Pubmed, Medline and Google Scholar, considering empirical studies and reviews exclusively in the English language. Maternal MS appears not to be associated with emotional and behavioral problems, as evaluated through retrospective studies. However, a specific cognitive and behavioral phenotype, through the administration of standardized instruments, has not been delineated yet. Available studies on the topic are characterized by poor methodology and do not lead to conclusions. This overview highlights implications for further longitudinal studies which should delineate offspring developmental trajectories, taking into consideration maternal confounding factors and the exposure to pharmacological treatment in pregnancy.
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Affiliation(s)
- Martina Siracusano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Elisa Carloni
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Assia Riccioni
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
| | - Marialaura Ferrara
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Chiara Scoppola
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
| | - Lucrezia Arturi
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
| | - Cinzia Niolu
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
- Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Girolama Alessandra Marfia
- MS Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Department of Neurosciences, Policlinico Tor Vergata Foundation Hospital, Viale Oxford 81, 00133 Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Montpellier Street 1, 00133 Rome, Italy
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Mainguy M, Tillaut H, Degremont A, Le Page E, Mainguy C, Duros S, Polard E, Leray E. Assessing the Risk of Relapse Requiring Corticosteroids After In Vitro Fertilization in Women With Multiple Sclerosis. Neurology 2022; 99:e1916-e1925. [PMID: 35953288 DOI: 10.1212/wnl.0000000000201027] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Several studies have shown an increased risk of relapse after in vitro fertilization (IVF) in women with multiple sclerosis (MS), especially when a gonadotrophin-releasing hormone (GnRH) agonist stimulation protocol was used. Our objective was to investigate the risk of relapse after IVF in women with MS, overall and according to stimulation protocol (GnRH agonists vs antagonists), using data from the French national health insurance database. METHODS This retrospective cohort study included all women with MS who have benefited from IVF between January 1, 2010, and December 31, 2015, in France. Three-month exposed periods after IVF were compared with unexposed periods before IVF, each woman being her own control. Four outcomes were considered: annualized relapse rate (ARR), proportion of IVF with relapse, difference in the number of relapses "after-before," and the delay from IVF to the first relapse. Relapses were identified by an algorithm based on MS-related hospital admissions and the use of corticosteroid therapy. Stimulation protocols and disease-modifying therapies (DMTs) were identified using drug claims. Zero-inflated Poisson regression models adjusted for age at IVF and the presence of DMT were used. A random effect on women was included because women may undergo multiple IVF procedures. Subgroup analyses by stimulation protocol and IVF outcome (pregnancy or failure) were conducted. RESULTS A total of 225 women accounting for 338 IVF procedures were included (the mean age at the first IVF 34.6 ± 4.5 years; 36% of women underwent at least 2 IVF procedures during the period). No increase in the risk of relapse after IVF was found overall (before vs after IVF: 0.20 vs 0.18 relapse per patient-year; 7.7% vs 7.1% of IVF with women having at least one relapse) and in subgroups. A lower ARR before and after IVF was observed among women who remained treated until IVF. DISCUSSION The maintenance of DMT until IVF seemed to be a determining factor in reducing the risk of relapse. Women with MS should be reassured because we did not show an increased risk of relapse requiring the use of corticosteroid therapy after IVF neither with GnRH agonists nor with GnRH antagonists.
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Affiliation(s)
- Marie Mainguy
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Hélène Tillaut
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Adeline Degremont
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Emmanuelle Le Page
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Christelle Mainguy
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Solène Duros
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Elisabeth Polard
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France
| | - Emmanuelle Leray
- From the Univ Rennes (M.M., E.L.), EHESP, CNRS, Inserm, ARENES-UMR, France; Univ Rennes (H.T.), Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR, Rennes, France; Pharmacovigilance (A.D., E.P.), Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, France; Neurology Department CRCSEP (E.L.P.), Rennes Clinical Investigation Centre CIC-P, Rennes University Hospital Rennes University INSERM, France; and Department of Gynecology Obstetric and Reproductive Medecine (C.M., S.D.), University Hospital, Rennes, France.
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10
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The Rate of Hospitalization of Pregnant Women with Multiple Sclerosis in Poland. J Clin Med 2022; 11:jcm11195615. [PMID: 36233482 PMCID: PMC9572960 DOI: 10.3390/jcm11195615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022] Open
Abstract
Multiple sclerosis (MS) is most often diagnosed in women of childbearing age. Therefore, it is important to examine the impact of pregnancy on the course of MS and to enable patients to make decisions about motherhood based on reliable data. The main objective of this study was to assess the impact of pregnancy on the course of MS by comparing the frequency of MS-related hospitalizations during pregnancy and 40 weeks postpartum versus 40 weeks before pregnancy. We used administrative health claims to identify female patients with MS, their deliveries, and their MS-related hospital admissions and calculated the frequency of MS-related hospital admissions before, during, and after pregnancy. We observed that MS is diagnosed approximately three times less often during pregnancy than before or after pregnancy. The number of MS-related hospital admissions decreased during pregnancy, especially in the third trimester. In contrast with other studies, we did not observe an increased level of MS-related admissions postpartum. The number of hospitalizations reported with steroid injections and emergency department visits also decreased during pregnancy. Our results show that pregnancy has a protective effect on the course of MS.
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11
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Capone F, Albanese A, Quadri G, Di Lazzaro V, Falato E, Cortese A, De Giglio L, Ferraro E. Disease-Modifying Drugs and Breastfeeding in Multiple Sclerosis: A Narrative Literature Review. Front Neurol 2022; 13:851413. [PMID: 35493841 PMCID: PMC9051389 DOI: 10.3389/fneur.2022.851413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Pregnancy-related issues in women with multiple sclerosis (MS) have been receiving increasing attention, with particular interest for the use of disease-modifying therapies (DMTs) before conception, during pregnancy, and postpartum, including breastfeeding. The risk of relapse is higher in the early postpartum period, especially in cases of significant disease activity prior to pregnancy, and thus treatment resumption and/or switching strategies might be necessary. Moreover, breastfeeding provides unmatched health benefits for babies and mothers, and is recommended as the best source of nutrition for infants. Furthermore, a protective role of breastfeeding on MS disease course has not been fully demonstrated and it remains debatable. At the same time, a source of concern is the potential transfer of DMTs into breastmilk and the resulting infant exposure. The use of most DMTs is unlicensed during breastfeeding mainly due to the limited data available on the excretion in human milk and on the effects on infants' exposure. Consequently, women have to face the difficult challenge of choosing between breastfeeding and DMT resumption. The present narrative review summarizes and discusses the available evidence on the safety of DMTs during breastfeeding and the relative approved labels. At the time of diagnosis of MS, specific counseling should be offered to women of childbearing age, making them aware of the possible therapeutic options and their impact on pregnancy and breastfeeding. Women can be encouraged to breastfeed, if clinically feasible, following a review of their medications and clinical status, with a personalized approach.
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Affiliation(s)
- Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico, Rome, Italy
- *Correspondence: Fioravante Capone
| | - Angela Albanese
- Merck Serono S.p.A., An Affiliate of Merck KGaA, Rome, Italy
| | - Giorgia Quadri
- Merck Serono S.p.A., An Affiliate of Merck KGaA, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico, Rome, Italy
| | - Emma Falato
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico, Rome, Italy
| | - Antonio Cortese
- Multiple Sclerosis Centre, S. Filippo Neri Hospital, Rome, Italy
| | - Laura De Giglio
- Multiple Sclerosis Centre, S. Filippo Neri Hospital, Rome, Italy
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12
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Ines Ciplea A, Kurzeja A, Thiel S, Haben S, Alexander J, Adamus E, Hellwig K. Eighteen-month safety analysis of offspring breastfed by mothers receiving glatiramer acetate therapy for relapsing multiple sclerosis - COBRA study. Mult Scler 2022; 28:1641-1650. [PMID: 35362346 PMCID: PMC9315183 DOI: 10.1177/13524585221083982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Safety data on disease-modifying therapies (DMTs) for relapsing multiple
sclerosis (RMS) during breastfeeding are limited. Objective: Assess safety outcomes for offspring breastfed by mothers undergoing
glatiramer acetate (GA; Copaxone®) treatment. Methods: This non-interventional, retrospective study used German Multiple Sclerosis
and Pregnancy Registry data. Participants had RMS, a live birth, and
received GA or no DMT during breastfeeding. Results: GA cohort: 58 mothers/60 offspring; matched controls: 60 mothers/60
offspring; 86.7% (GA) and 25% (control) of offspring were born to mothers
who had GA at some point during pregnancy. Maternal demographics and disease
activity were comparable. Annualized number of hospitalizations was similar
for breastfed offspring: 0.20 (95% confidence interval: 0.09–0.31; GA) and
0.25 (0.12–0.38, controls). Proportion of offspring requiring
hospitalization was comparable between cohorts (18.33% vs. 20.00%).
Annualized number of antibiotic uses was similar in both cohorts (0.22,
0.10–0.33 (GA) vs. 0.17, 0.06–0.27 (controls)) The proportion of offspring
requiring antibiotics was 15.00% (both cohorts). More developmental delays
were identified in controls versus the GA cohort (3 (5.36%) vs. 0). Growth
parameters were comparable between cohorts. Conclusion: Maternal intake of GA during breastfeeding did not adversely affect offspring
safety outcomes assessed during the first 18 months of life.
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Affiliation(s)
- Andrea Ines Ciplea
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Anna Kurzeja
- European Medical Affairs, Teva Pharmaceuticals Europe B.V., Amsterdam, The Netherlands
| | - Sandra Thiel
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sabrina Haben
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | | | - Evelyn Adamus
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum, Ruhr University Bochum, Bochum, Germany
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13
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McCombe PA. The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do? Expert Rev Neurother 2022; 22:377-392. [PMID: 35354378 DOI: 10.1080/14737175.2022.2060079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is more prevalent in women than in men. The sex of the patient, and pregnancy, are reported to be associated with the clinical features of MS. The mechanism of this is unclear. AREAS COVERED This review summarizes data about sex differences in MS and the role of pregnancy. Possible mechanisms for the effects of sex and pregnancy are summarized, and practical suggestions for addressing these issues are provided. EXPERT OPINION There is considerable interdependence of the variables that are associated with MS. Men have a worse outcome of MS, and this could be due to the same factors that lead to greater incidence of neurodegenerative disease in men. The possible role of parity on the long-term outcome of MS is of interest. Future studies that look at the mechanisms of the effects of the sex of the patient on the outcome of MS are required. However, there are some actions that can be taken without further research. We can concentrate on public health measures that address the modifiable risk factors for MS and ensure that disease is controlled in women who intend to become pregnant and use appropriate disease modifying agents during pregnancy.
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Affiliation(s)
- Pamela A McCombe
- The University of Queensland, Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, Australia
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14
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Rommer P, Zettl UK. Treatment options in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. Curr Pharm Des 2021; 28:428-436. [PMID: 34544336 DOI: 10.2174/1381612827666210920151231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
There are few diseases with as many therapeutic advances in recent years as in multiple sclerosis. Nine different drug classes with more than a dozen approved therapies are now available. Similarly, there have been unimaginable advances in understanding neuromyelitis optica (now neuromyelitis optica spectrum disorder [NMOSD]) over the past 15 years. Building on the knowledge gained, the first therapies have been approved in recent years. In this review, we aim to present all therapies approved for the treatment of MS or NMOSD. The different forms of application, different approval criteria and most important side effects will be presented. This work is intended for physicians who are interested in MS and NMOSD therapies and want to get a first overview and does not replace the respective guidelines of the regulatory authorities.
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Affiliation(s)
- Paulus Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock. Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock. Germany
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15
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Tillaut H, Degrémont A, Kerbrat S, Roux J, Le Page E, Mainguy C, Duros S, Polard E, Leray E. Pregnancy in women with multiple sclerosis in France from 2010 to 2015: Incidence, outcomes, and exposure to disease-modifying therapies. Mult Scler 2021; 28:778-789. [PMID: 34410176 DOI: 10.1177/13524585211035376] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is usually diagnosed between 20-40 years old, when women often plan to have children. OBJECTIVE Our objectives were to estimate pregnancy incidence rates in women with multiple sclerosis (MS), and to describe the use of disease-modifying therapies (DMTs) before conception and during pregnancy, and pregnancy outcomes. METHODS This retrospective cohort study included all 15- to 49-year-old women with MS in the French national health insurance database over 2010-2015. A pregnancy was exposed if a DMT reimbursement claim occurred during pregnancy or in the 14 preceding days. We used zero-inflated negative binomial (ZINB) regression models to estimate incidence rates and ordinal and multinomial regression models to estimate DMT exposure and pregnancy outcomes. RESULTS The pregnancy incidence rate was 4.5 per 100 person-years. The probability of having a DMT-exposed pregnancy increased from 0.22 in 2010 to 0.30 in 2015. The probability of live birth was 0.72 (95% CI = 0.70-0.74) for exposed pregnancies (varied considerably among DMTs), 0.77 (95% CI = 0.76-0.79) without treatment, and 0.81 (95% CI = 0.79-0.83) if treatment was stopped within the previous year. CONCLUSION In this population-based study, we showed an increase of exposed pregnancies over time, beta-interferon and glatiramer acetate being the most used DMTs and associated with the highest probabilities of live birth. Interrupted exposed pregnancies may reflect undesired pregnancies or fear of an adverse outcome, while recent DMT stop probably reflects pregnancy planning.
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Affiliation(s)
- Hélène Tillaut
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), University of Rennes, École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Adeline Degrémont
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), University of Rennes, École des Hautes Études en Santé Publique (EHESP), Rennes, France/Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | - Sandrine Kerbrat
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), University of Rennes, École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Jonathan Roux
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), University of Rennes, École des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Emmanuelle Le Page
- Department of Neurology, Rennes University Hospital, Rennes, France/University of Rennes, CHU Rennes, INSERM, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Christelle Mainguy
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes, France
| | - Solène Duros
- Department of Gynecology and Obstetrics, Rennes University Hospital, Rennes, France
| | - Elisabeth Polard
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), University of Rennes, École des Hautes Études en Santé Publique (EHESP), Rennes, France/Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, Rennes, France
| | - Emmanuelle Leray
- EA 7449 REPERES (Pharmacoepidemiology and Health Services Research), University of Rennes, Département Méthodes Quantitatives en Santé Publique (MÉTIS), École des Hautes Études en Santé Publique (EHESP), Rennes, France/University of Rennes, CHU Rennes, INSERM, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
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Simone IL, Tortorella C, Ghirelli A. Influence of Pregnancy in Multiple Sclerosis and Impact of Disease-Modifying Therapies. Front Neurol 2021; 12:697974. [PMID: 34276545 PMCID: PMC8280312 DOI: 10.3389/fneur.2021.697974] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 01/25/2023] Open
Abstract
Purpose of this Review: This article is a systematic review on the influence pregnancy has on multiple sclerosis and the resulting impact of disease-modifying therapies. Findings: Multiple sclerosis predominantly affects young women with a clinical onset most often during the child-bearing age. The impact of multiple sclerosis and disease-modifying therapies on fertility, pregnancy, fetal outcome, and breastfeeding is a pivotal topic when it comes to clinical practice. The introduction of disease-modifying therapies has changed not only the natural history of the disease but also the perspective of pregnancy in women with multiple sclerosis. Family planning requires careful consideration, especially because many disease-modifying drugs are contraindicated during pregnancy. In this article, we review current evidence collected from published literature and drug-specific pregnancy registers on the use of disease-modifying therapies. Additionally, we discuss safety profiles for each drug and correlate them to both risk for the exposed fetus and risk for the mothers interrupting treatments when seeking pregnancy.
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Affiliation(s)
- Isabella Laura Simone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alma Ghirelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
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Colaceci S, Zambri F, Marchetti F, Trivelli G, Rossi E, Petruzzo A, Vanacore N, Giusti A. 'A sleeping volcano that could erupt sooner or later'. Lived experiences of women with multiple sclerosis during childbearing age and motherhood: A phenomenological qualitative study. Mult Scler Relat Disord 2021; 51:102938. [PMID: 33882427 DOI: 10.1016/j.msard.2021.102938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Multiple Sclerosis (MS) mainly involves women, impacting many aspects related to childbearing age and maternity. Women with MS can have healthy pregnancies and infants. Needs, challenges and concerns of women with MS should be considered in order to improve care pathway, ensuring a patient-centred approach. Therefore, the aim of this study was to explore personal experiences, expectations, fears in women with MS. METHODS A descriptive phenomenological study, including women with MS during childbearing age, pregnancy and motherhood, carried out from January to April 2019. Women, enrolled in a MS centre with snowball sampling through healthcare network, were invited for a face-to-face or phone interview, digitally audio-recorded and fully transcribed. Two different sets of semi-structured interviews were developed (woman seeking pregnancy / pregnant woman and mother), together with an anonymous form, to collect some main sociodemographic data. Categorical data analysis, inductively and deductively, was processed by 3 different researchers, using Creswell extension to reduce subjective influences. QDA Miner qualitative text analysis software was used. RESULTS The following 6 deductive themes emerged: 1) experience with diagnosis of MS; 2) relationship with the partner, children, and family; 3) pregnancy; 4) delivery; 5) puerperium; 6) care pathway. Experiences with diagnosis can be very different between women. Communication of MS diagnosis appears as an opportunity to strengthen emotional ties, despite sorrow and concerns. Reasons for quarrels and disagreements, both in couple and parents, were due to an overly protective and supportive attitude. Some participants reported difficulty of conceiving. Pregnancy is described as a state of wellbeing, not devoid by fears and worries. Women experienced fatigue and exhaustion especially during the second stage of labour, but spontaneous delivery is described as an empowering experience. Findings about breastfeeding confirm that healthcare professionals have a crucial role regarding initiation, duration and type of breastfeeding and often scarce education and training on the topic, together with lack of reliable scientific sources, lead to a conservative approach. Healthcare providers communication and consulting emerge as indispensable skills. CONCLUSION The study provides a better understanding of how MS impacts women' life during childbearing age, pregnancy and motherhood. Findings support the importance of provide quality and tailored care for women with MS, according to an empathetic and patient-centred approach. Further research should be more comprehensive explorations of mothers' experiences in different cultural contexts, but also partners and offspring of women with MS.
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Affiliation(s)
- Sofia Colaceci
- Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy.
| | - Francesca Zambri
- National Centre for Diseases Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Francesca Marchetti
- National Centre for Diseases Prevention and Health Promotion, National Institute of Health, Rome, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gessica Trivelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Rossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Nicola Vanacore
- National Centre for Diseases Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Angela Giusti
- National Centre for Diseases Prevention and Health Promotion, National Institute of Health, Rome, Italy
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18
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Anheim M. Neurology and pregnancy: The delivery. Rev Neurol (Paris) 2021; 177:166-167. [PMID: 33706970 DOI: 10.1016/j.neurol.2021.02.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- M Anheim
- Service de neurologie, centre de référence neurogénétique, centre expert Parkinson, hôpitaux universitaires de Strasbourg, Strasbourg, France; Inserm-U964/CNRS-UMR7104/, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France; Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France.
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