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Hellwig K, Rog D, McGuigan C, Houtchens MK, Bruen DR, Mokliatchouk O, Branco F, Levin S, Everage N, Lin X. Final analysis of 379 pregnancy outcomes after exposure to dimethyl fumarate in a prospective international registry. Mult Scler 2024; 30:209-215. [PMID: 38166480 DOI: 10.1177/13524585231220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND Dimethyl fumarate (DMF) has a favorable benefit-risk profile treating people with multiple sclerosis and should be used in pregnant women only if the potential benefits outweigh potential risks to the fetus. OBJECTIVE Assess pregnancy outcomes in a completed international registry (TecGistry) of women with MS exposed to DMF. METHODS TecGistry included pregnant women with MS exposed to DMF, with data collected at enrollment, 6-7 months gestation, 4 weeks after estimated due date, and at postpartum weeks 4, 12, and 52. Outcomes included live births, gestational size, pregnancy loss, ectopic/molar pregnancies, birth defects, and infant/maternal death. RESULTS Of 397 enrolled, median (range) age was 32 years (19-43). Median (range) gestational week at enrollment was 10 (0-39) and at first DMF exposure was 1 (0-13). Median (range) duration of gestational DMF exposure was 5 weeks (0-40). Fifteen (3.8%) spontaneous abortions occurred. Of 360 (89.1%) live births, 323 were full term and 37 were premature. One neonatal death and no maternal deaths occurred. Adjudicator-confirmed EUROCAT birth defects were found in 2.2%. CONCLUSION DMF exposure during pregnancy did not adversely affect pregnancy outcomes; birth defects, preterm birth, and spontaneous abortion were in line with rates from the general population.
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Affiliation(s)
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Christopher McGuigan
- Department of Neurology, University College Dublin and St. Vincent's University Hospital, Dublin, Ireland
| | - Maria K Houtchens
- The Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Weinstock-Guttman B, Ross AP, Planton J, White K, Pandhi A, Greco A, Kumar A, Everage N, Vignos M. Analysis of Pregnancy Outcomes Following Exposure to Intramuscular Interferon Beta-1a: The AVONEX ® Pregnancy Exposure Registry. Drugs Real World Outcomes 2023; 10:503-511. [PMID: 37737962 PMCID: PMC10730480 DOI: 10.1007/s40801-023-00384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of well-controlled US studies of intramuscular (IM) interferon beta (IFNβ)-1a use in pregnant women with multiple sclerosis; however, in the European Medicines Agency region, IFNβ formulations may be considered during pregnancy if clinically needed based on data from European Union cohort registries. The AVONEX Pregnancy Exposure Registry was established to prospectively study the effects of IM IFNβ-1a on the risk of birth defects and spontaneous pregnancy loss in a US population. METHODS Pregnant women with multiple sclerosis exposed to IM IFNβ-1a within ~ 1 week of conception or during the first trimester were included. Participants were followed until there was a pregnancy outcome, live-born infants were followed until age 8-12 weeks. Data were collected on IM IFNβ-1a exposure, demographics, patient characteristics, medical history, and pregnancy outcomes, including live births (with or without birth defect), spontaneous abortions/miscarriages and fetal death/stillbirth, elective abortions (with and without birth defect), and ectopic pregnancies. A population-based birth defect surveillance program, the Metropolitan Atlanta Congenital Defects Program (MACDP), served as the primary external control group for evaluating the risk of birth defects. RESULTS Three-hundred and two patients with a median (range) age of 31.0 (16-48) years and a median (range) gestational age at the time of enrollment of 10.1 (4-39) weeks were evaluable. Most patients (n = 278/302; 92%) reported IM IFNβ-1a exposure in the week before conception and most (n = 293/302; 97%) discontinued treatment before the end of the first trimester. Of 306 pregnancy outcomes, there were 272 live births, 28 spontaneous abortions of 266 pregnancies enrolled before 22 weeks' gestation (rate 10.5%; 95% confidence interval 7.2-15.0), five elective abortions, and one stillbirth. There were 17 adjudicator-confirmed major birth defects of 272 live births (rate 6.3%; 95% confidence interval 3.8-10.0); the pattern of birth defects observed was not suggestive of a relationship to prenatal IM IFNβ-1a exposure. CONCLUSIONS This large US registry study suggests IM IFNβ-1a exposure during early pregnancy was not clinically associated with adverse pregnancy outcomes in women with multiple sclerosis. These findings help inform clinicians and patients in weighing the risks and benefits of IM IFNβ-1a use during pregnancy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT00168714, 15 September, 2005.
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Affiliation(s)
- Bianca Weinstock-Guttman
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, 1010 Main St, 2nd floor, Buffalo, NY, 14202, USA
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Lyons J, Hughes R, McCarthy K, Everage N, Kapadia S, Miller C, Singhal P, Smirnakis K. Progressive multifocal leukoencephalopathy outcomes in patients with multiple sclerosis treated with dimethyl fumarate. Mult Scler J Exp Transl Clin 2022; 8:20552173221132469. [PMID: 36387034 PMCID: PMC9661630 DOI: 10.1177/20552173221132469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Dimethyl fumarate (DMF), an oral disease-modifying therapy with an established benefit and well-described safety profile, is among the most commonly used therapies for relapsing forms of multiple sclerosis. As of 31 December 2021, >560,000 patients have been treated with DMF, representing >1,190,000 person-years of exposure. Of these, 6413 patients (14,292 person-years) were from clinical trials. Methods and results Progressive multifocal leukoencephalopathy (PML) has occurred in the setting of lymphopenia (<0.91 × 109/L) in patients treated with DMF. We present detailed clinical characteristics and outcomes of the 12 confirmed PML cases occurring in MS patients on DMF as of 21 July 2021. The PML incidence in DMF-treated patients is 1.07 per 100,000 person-years of DMF exposure. Lymphopenia is the common risk for PML in DMF treatment. Discussion DMF-related PML is rare but has occurred in the setting of lymphopenia, supporting the current recommendations for absolute lymphocyte count monitoring in all patients, regardless of age and time on therapy.
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Affiliation(s)
- Jennifer Lyons
- Jennifer Lyons, Biogen, 225 Binney Street, Cambridge, MA 02142, USA.
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Rog D, Hellwig K, McGuigan C, Mokliatchouk O, Branco F, Lyons J, Everage N. 151 Updated analysis of pregnancy outcomes for patients with MS in a dimethyl fumarate exposure registry. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionDimethyl fumarate (DMF) is not recommended during pregnancy and should only be used if the potential benefit justifies potential foetal risk. Given limited pregnancy data, the UK and Ireland have enrolled DMF-exposed pregnant women in an ongoing international registry assessing pregnancy outcomes. In the general population, 62% of pregnancies end in live birth, 22% in abortion, and 16% in foetal loss, with similar rates in multiple sclerosis (MS) patients.MethodsWomen with MS exposed to DMF since the first day of their last menstrual period before con- ception/during pregnancy were included. UK/Ireland Coordinating Centres liaised directly with patients and healthcare providers.ResultsAs of March 2021, 403 patients (19 UK/Ireland) were enrolled. Of 350 reported pregnancy outcomes (19 UK/Ireland), 329 (94%) represented live births (100% UK/Ireland). Of 326 infants with known gestational age,298 births (91%) were full-term (100% UK/Ireland) and 28 (9%) premature (<37 weeks). Of the 21 (6%) cases of foetal loss, 19 were spontaneous abortions (1 each ectopic and molar pregnancy) and 2 foetal deaths (>28 weeks). There was one neonatal death. Nine infants (2 UK/Ireland) had EUROCAT-confirmed birth defects.ConclusionsThe observations are consistent with MS and general populations.SupportBiogen. Disclosures on poster.
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Hellwig K, Rog D, McGuigan C, Mokliatchouk O, Branco F, Peng X, Everage N. 112 Updated analysis of pregnancy outcomes in a dimethyl fumarate exposure registry. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionDimethyl fumarate (DMF) is not recommended for use during pregnancy and should only be used if the potential benefit justifies the potential foetal risk. Given limited pregnancy data, the UK and Ireland have enrolled DMF-exposed pregnant women in an ongoing international registry assessing pregnancy outcomes. Generally, pregnancies end in live birth (62%), abortion (22%), or foetal loss (16%), with similar rates in MS patients.MethodsPregnant women with MS exposed to DMF since the first day of their last menstrual period before conception/during pregnancy were included. UK/Ireland Coordinating Centres liaise directly with patients and healthcare providers.ResultsAs of May 2020, 345 patients (18 UK/Ireland) were enrolled. Of the reported 351 pregnancy outcomes (18 UK/Ireland), 277 (79%) represented live births (17 UK/Ireland) and 74 (21%) foetal loss. Of infants with known gestational age (n=274), 249 births (91%) were full-term (17 UK/Ireland) and 25 (9%) premature (<37 weeks). There were 17 spontaneous abortions (1 each ectopic and molar pregnancy) and 1 foetal death (at >28 weeks). No infant or maternal deaths were reported. Ten infants (4%) (2 UK/Ireland) had confirmed birth defects.ConclusionsObserved safety signals were consistent with MS and general populations.SupportBiogen. Disclosures: Included on poster 81david.rog@srft.nhs.uk
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Korjagina M, Hakkarainen KM, Burkill S, Geissbühler Y, Sabidó M, Everage N, Suzart-Woischnik K, Klement R, Hillert J, Verkkoniemi-Ahola A, Bahmanyar S, Montgomery S, Korhonen P. Prevalence of adverse pregnancy outcomes after exposure to interferon beta prior to or during pregnancy in women with MS: Stratification by maternal and newborn characteristics in a register-based cohort study in Finland and Sweden. Mult Scler Relat Disord 2020; 48:102694. [PMID: 33429303 DOI: 10.1016/j.msard.2020.102694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/06/2020] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies reported no increase in the prevalence of adverse pregnancy outcomes after exposure to interferon-beta (IFN-beta). However, no study has investigated if the prevalence of these outcomes after IFN-beta exposure is modified by maternal and newborn characteristics. Our objective was to describe the stratified prevalence of adverse pregnancy outcomes among women with multiple sclerosis (MS) exposed only to IFN-beta or unexposed to any MS disease modifying drugs (MSDMDs). METHODS This population-based cohort study using Finnish (1996-2014) and Swedish (2005-2014) register data included pregnancies of women with MS exposed only to IFN-beta 6 months before or during pregnancy (n=718) or unexposed to MSDMDs (n=1397). The outcome prevalences were described stratified by maternal and newborn characteristics, with 95% confidence intervals (CIs). Confounder-adjusted analyses were performed if the prevalence results indicated modified effect of IFN-beta in specific strata. RESULTS The stratified analysis indicated that the prevalence of serious (anomaly or stillbirth) and other adverse pregnancy outcomes was similar among the exposed and unexposed, with no statistically significant difference. Among women treated for MS >5 years, serious adverse pregnancy outcomes occurred in 4.3% (95%CI: 1.9-8.3%) of pregnancies exposed only to IFN-beta 6 months before or during pregnancy and in 2.7% (95%CI: 1.2-5.0%) of unexposed pregnancies. The confounder adjusted analyses did not support the hypothesis that MS treatment duration before pregnancy would modify the risk of adverse pregnancy outcomes after exposure to IFN-beta 6 months before or during pregnancy. CONCLUSION The prevalence of adverse pregnancy outcomes was not increased after IFN-beta exposure, when pregnancies of women with MS were stratified by maternal and newborn characteristics. The stratified results were similar to the unstratified results in the same population.
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Affiliation(s)
- Marta Korjagina
- StatFinn-EPID Research, Paldiski mnt 29, 10612, Tallinn, Estonia
| | | | - Sarah Burkill
- Karolinska Institute, Solnavägen 1, 171 77 Solna, Sweden
| | - Yvonne Geissbühler
- Novartis Pharma AG, Evidence and Launch Excellence, Asklepios 8-3, Postfach, CH-4002 Basel, Switzerland
| | | | | | | | - Riho Klement
- StatFinn-EPID Research, Narva maantee 3, 51009 Tartu, Estonia
| | - Jan Hillert
- Karolinska Institute, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Auli Verkkoniemi-Ahola
- Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden; Centre for Psychiatry Research, Karolinska Institutet, Norra Stationsgatan 69, floor 7, 113 64 Stockholm, Sweden; Stockholm Health Care Services, Solnavägen 1 E, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Solnavägen 1, 171 77 Solna, Sweden; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital and Örebro University, Fakultetsgatan 1, 701 82 Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Pasi Korhonen
- StatFinn-EPID Research, Metsänneidonkuja 6, 02130 Espoo, Finland
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Tennis P, Chan KA, Curkendall SM, Li DK, Mines D, Peterson C, Andrews EB, Calingaert B, Chen HY, Deshpande G, Everage N, Holick CN, Meyer NM, Nkhoma ET, Quinn S, Rothman KJ, Esposito DB. Topiramate use during pregnancy and major congenital malformations in multiple populations. ACTA ACUST UNITED AC 2015; 103:269-75. [PMID: 25776342 DOI: 10.1002/bdra.23357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/06/2015] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND We measured birth prevalence of major congenital malformations (MCMs) after topiramate use during pregnancy to screen for a possible signal of increased risk. METHODS Using four healthcare databases, we identified three cohorts of pregnant women: cohort 1, used topiramate during the first trimester; cohort 2, used topiramate or another antiepileptic drug previously but not during pregnancy; and cohort 3, were pregnant and did not use topiramate but had indications for use individually matched to those of users. Cohort 1 was compared with cohorts 2 and 3. MCMs were a code for any major congenital malformation dated within 30 days of the delivery date on the mother's claims or within 365 days after infant birth date, excluding a genetic or syndromic basis, and with procedure or healthcare usage consistent with the MCM diagnosis code in the 365 days after infant birth. RESULTS Of the 10 specific common MCMs evaluated, 1 (conotruncal heart defects) had a prevalence ratio greater than 1.5 for both primary comparisons, and 4 (ventricular septal defect, atrial septal defect, hypospadias, coarctation of the aorta) had a prevalence ratio greater than 1.5 for one of the two comparisons. Following screening of organ systems with elevated MCMs, the prevalence ratio was greater than 1.5 for patent ductus arteriosus in both comparisons and for obstructive genitourinary defects in one comparison. CONCLUSION To evaluate a large number of MCMs across many pregnancies, we used crude methods for detecting potential signals. Therefore, these results should be seen as potential signals, not causal.
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Affiliation(s)
- Patricia Tennis
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
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Mines D, Tennis P, Curkendall SM, Li DK, Peterson C, Andrews EB, Calingaert B, Chen H, Deshpande G, Esposito DB, Everage N, Holick CN, Meyer NM, Nkhoma ET, Quinn S, Rothman KJ, Chan KA. Topiramate use in pregnancy and the birth prevalence of oral clefts. Pharmacoepidemiol Drug Saf 2014; 23:1017-25. [DOI: 10.1002/pds.3612] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/23/2014] [Accepted: 02/17/2014] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - De-Kun Li
- Division of Research, Kaiser Foundation Research Institute; Kaiser Permanente; Oakland CA USA
| | | | | | | | - Hong Chen
- Division of Research, Kaiser Foundation Research Institute; Kaiser Permanente; Oakland CA USA
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Lambert EV, Steyn K, Stender S, Everage N, Fourie JM, Hill M. Cross-cultural validation of the hill-bone compliance to high blood pressure therapy scale in a South African, primary healthcare setting. Ethn Dis 2006; 16:286-91. [PMID: 16599385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVES Hypertension is prevalent, under-diagnosed, and inadequately treated in Black South Africans. However, few studies have addressed barriers to hypertension care and control in this community. The aim of this study was to validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB Comp Scale) for use in a South African primary healthcare setting. This instrument consists of three subscales, medications-compliance, appointment making, and salt intake. METHODS A demographic questionnaire and the HB scale were translated into the first language of the subjects and then back-translated into English. Hypertensive patients (N=98) were recruited from primary healthcare clinics in Cape Town. Blood pressure was measured with an Omron electronic blood pressure manometer, after 5 min of seated rest. Item-analysis was conducted to determine internal consistency of the HB Comp Scale; Spearman rank order correlations were used to assess the relationship between compliance scores and blood pressure. RESULTS A modified scale consisting of only 10 items demonstrated reasonable internal consistency (item-total correlations all >.31, and a standardized Cronbach alpha of 0.79), with an average interitem correlation of .26. In addition, the modified scale had significant predictive validity in that noncompliance predicted higher diastolic blood pressures (p=.21, P<.05) and medication noncompliance tended to predict higher systolic blood pressures (p=.20, P<.06). Appointment-making and dietary salt-intake subscales were not internally consistent. CONCLUSIONS We demonstrated criterion validity and internal consistency for a modified Hill-Bone Compliance Scale, in Black, urban, hypertensive, South African patients. Results compare favorably with those from an urban African-American setting (standardized Cronbach alpha was .74-.84).
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