Long-term outcome of pregnant women with neuromyelitis optica spectrum disorder
ECTRIMS Online Library. Kim S. 09/13/19; 278293; P1091
Dr. Su-Hyun Kim
Dr. Su-Hyun Kim
Contributions
Abstract

Abstract: P1091

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS Variants

S.-H. Kim1, S.-Y. Huh2, H.-M. Jang1, N.Y. Park1, M.Y. Lee1, J.-W. Hyun1, H.J. Kim1

1Institute and Hospital of National Cancer Center, Goyang, 2Kosin University College of Medicine, Busan, Republic of Korea

Introduction: Since Neuromyelitis optica spectrum disorder (NMOSD) commonly affects women of childbearing age, the effect of pregnancy on fetal and maternal outcome is an important issue.
Objectives: To investigate long-term effect of pregnancy on disease outcome in women who had pregnancy after NMOSD onset
Methods: Based on clinical data of 128 women with NMOSD (age at onset < 46 and current age >19), the long-term effect of pregnancy was analyzed by comparing two groups: patients who were pregnant after NMOSD onset (group I) versus patients who were never pregnant or only pregnant before disease onset (group II).
Results: After a median disease duration of 12 years, 17 (13%) women reached EDSS score of 6.0. Of total patients, 28 women had 35 pregnancies after NMOSD onset. The median age at onset was 26 years and the median age at conception was 31 years. The pregnancies ended in 26 (74%) live births (healthy neonates except one with low birth weight), 6 (17%) miscarriages, and 3 (9%) elective abortions. There were 14 pregnancies in 13 women before immunosuppressive therapy (IST) while there were 21 pregnancies in 17 women after median 57 months of IST (azathioprine [n=3], mycophenolate mofetil [n=2], mitoxantrone followed by mycophenolate mofetil [n=1] and rituximab [n=15]). Acute attack during pregnancy or postpartum occurred in 7 (50%) of 14 pregnancies before IST, but in only 5 (24%) of 21 pregnancies after IST. When comparing the 28 women in group I with 100 women in group II, there were no significant differences in age at onset, disease duration, time to treatment, annualized relapse rate before and after treatment, type of IST, the EDSS score at last follow-up and proportion of patients with EDSS score ≥6.0.
Conclusions: With appropriate IST before pregnancy, pregnancy may not be associated with negative long-term outcome in NMOSD.
Disclosure: This work was supported by the National Research Foundation of Korea (Grant No. NRF-2016R1D1A1A09916480).

Kim SH has received a grant from the National Research Foundation
of Korea. Hyun JW, Jang HM, Park NY, and Lee MY report no disclosure. Kim HJ has lectured, consulted, and received honoraria from Bayer Schering Pharma, Biogen, Celltrion, Eisai, Genzyme, HanAll BioPharma, MedImmune, Merck Serono, Novartis, Teva-Handok and UCB; received a grant from the Ministry of Science & ICT; accepted research funding from
Genzyme, Kael-Gemvax, Merck Serono, Teva-Handok and UCB; serves
on a steering committee for MedImmune; is a coeditor for the Multiple
Sclerosis Journal—Experimental, Translational and Clinical, and an
associate editor for the Journal of Clinical Neurology.

Abstract: P1091

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS Variants

S.-H. Kim1, S.-Y. Huh2, H.-M. Jang1, N.Y. Park1, M.Y. Lee1, J.-W. Hyun1, H.J. Kim1

1Institute and Hospital of National Cancer Center, Goyang, 2Kosin University College of Medicine, Busan, Republic of Korea

Introduction: Since Neuromyelitis optica spectrum disorder (NMOSD) commonly affects women of childbearing age, the effect of pregnancy on fetal and maternal outcome is an important issue.
Objectives: To investigate long-term effect of pregnancy on disease outcome in women who had pregnancy after NMOSD onset
Methods: Based on clinical data of 128 women with NMOSD (age at onset < 46 and current age >19), the long-term effect of pregnancy was analyzed by comparing two groups: patients who were pregnant after NMOSD onset (group I) versus patients who were never pregnant or only pregnant before disease onset (group II).
Results: After a median disease duration of 12 years, 17 (13%) women reached EDSS score of 6.0. Of total patients, 28 women had 35 pregnancies after NMOSD onset. The median age at onset was 26 years and the median age at conception was 31 years. The pregnancies ended in 26 (74%) live births (healthy neonates except one with low birth weight), 6 (17%) miscarriages, and 3 (9%) elective abortions. There were 14 pregnancies in 13 women before immunosuppressive therapy (IST) while there were 21 pregnancies in 17 women after median 57 months of IST (azathioprine [n=3], mycophenolate mofetil [n=2], mitoxantrone followed by mycophenolate mofetil [n=1] and rituximab [n=15]). Acute attack during pregnancy or postpartum occurred in 7 (50%) of 14 pregnancies before IST, but in only 5 (24%) of 21 pregnancies after IST. When comparing the 28 women in group I with 100 women in group II, there were no significant differences in age at onset, disease duration, time to treatment, annualized relapse rate before and after treatment, type of IST, the EDSS score at last follow-up and proportion of patients with EDSS score ≥6.0.
Conclusions: With appropriate IST before pregnancy, pregnancy may not be associated with negative long-term outcome in NMOSD.
Disclosure: This work was supported by the National Research Foundation of Korea (Grant No. NRF-2016R1D1A1A09916480).

Kim SH has received a grant from the National Research Foundation
of Korea. Hyun JW, Jang HM, Park NY, and Lee MY report no disclosure. Kim HJ has lectured, consulted, and received honoraria from Bayer Schering Pharma, Biogen, Celltrion, Eisai, Genzyme, HanAll BioPharma, MedImmune, Merck Serono, Novartis, Teva-Handok and UCB; received a grant from the Ministry of Science & ICT; accepted research funding from
Genzyme, Kael-Gemvax, Merck Serono, Teva-Handok and UCB; serves
on a steering committee for MedImmune; is a coeditor for the Multiple
Sclerosis Journal—Experimental, Translational and Clinical, and an
associate editor for the Journal of Clinical Neurology.

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