The maternal perspective - When to stop/resume treatment and risk for progression
ECTRIMS Online Library. Portaccio E. 09/11/19; 279371; 19
Emilio Portaccio
Emilio Portaccio
Contributions
Abstract

Abstract: 19

Type: Hot Topic

Abstract Category: Hot Topic 2: MS Pregnancy in the treatment era

E. Portaccio

SOC Neurologia, AUSL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy

In the late nineties, the European multicentric Pregnancy in Multiple Sclerosis (PRIMS) study documented for the first time a significant decrease of relapse-rate during pregnancy in MS women, with activity restart early after delivery. In the same cohort, disability progression over the follow-up period was estimated to correspond to what is expected in the general population of MS patients. Therefore, the overall impact of pregnancy on MS course appeared to be neutral, at least in the short-term. However, the PRIMS study was carried out before the introduction of disease modifying drugs (DMD); since then, several disease modifying treatments have been approved, posing challenges for neurologist and MS women facing a pregnancy planning. As for the maternal perspective, DMD start delay or suspension due to pregnancy may deprive the patients of treatment benefit, exposing them to potential risk of relapses and disability progression, particularly in the post-partum period. Similarly to findings from the PRIMS study, in patients who are untreated or are receiving beta-interferons and glatiramer acetate, the relapse rate progressively reduces over the gestational period and peaks early after the delivery. The risk of post-partum relapses and disability progression is higher in women with higher disease activity in the year before pregnancy and is reduced by DMD resumption. The scenario appears to be different in MS patients receiving sequestrating agents, such as natalizumab. In women treated with natalizumab, relapses and disability progression occur in both gestational and post-partum periods, and are prevented maintaining the drug until conception and resuming it early after delivery. On the other hand, this approach must take into account possible fetal risks that need to be thoroughly discussed with the mother. Little is known on disease activity profile before, during and after pregnancy in MS women receiving the newer DMD that require further investigation and surveillance in future research. On the whole, the pregnancy-related decision-making process must be shared with the patient and her partner, on a case by case basis, with comprehensive information on known possible risks as well as current gaps in knowledge.
Disclosure: Emilio Portaccio served on scientific advisory board for Biogen Idec and Merck Serono, received honoraria for speaking and funding for traveling from Biogen, Genzyme, Novartis, Merck, and Teva, and received research support from Merck Serono

Abstract: 19

Type: Hot Topic

Abstract Category: Hot Topic 2: MS Pregnancy in the treatment era

E. Portaccio

SOC Neurologia, AUSL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy

In the late nineties, the European multicentric Pregnancy in Multiple Sclerosis (PRIMS) study documented for the first time a significant decrease of relapse-rate during pregnancy in MS women, with activity restart early after delivery. In the same cohort, disability progression over the follow-up period was estimated to correspond to what is expected in the general population of MS patients. Therefore, the overall impact of pregnancy on MS course appeared to be neutral, at least in the short-term. However, the PRIMS study was carried out before the introduction of disease modifying drugs (DMD); since then, several disease modifying treatments have been approved, posing challenges for neurologist and MS women facing a pregnancy planning. As for the maternal perspective, DMD start delay or suspension due to pregnancy may deprive the patients of treatment benefit, exposing them to potential risk of relapses and disability progression, particularly in the post-partum period. Similarly to findings from the PRIMS study, in patients who are untreated or are receiving beta-interferons and glatiramer acetate, the relapse rate progressively reduces over the gestational period and peaks early after the delivery. The risk of post-partum relapses and disability progression is higher in women with higher disease activity in the year before pregnancy and is reduced by DMD resumption. The scenario appears to be different in MS patients receiving sequestrating agents, such as natalizumab. In women treated with natalizumab, relapses and disability progression occur in both gestational and post-partum periods, and are prevented maintaining the drug until conception and resuming it early after delivery. On the other hand, this approach must take into account possible fetal risks that need to be thoroughly discussed with the mother. Little is known on disease activity profile before, during and after pregnancy in MS women receiving the newer DMD that require further investigation and surveillance in future research. On the whole, the pregnancy-related decision-making process must be shared with the patient and her partner, on a case by case basis, with comprehensive information on known possible risks as well as current gaps in knowledge.
Disclosure: Emilio Portaccio served on scientific advisory board for Biogen Idec and Merck Serono, received honoraria for speaking and funding for traveling from Biogen, Genzyme, Novartis, Merck, and Teva, and received research support from Merck Serono

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