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Incidence of pregnancy and disease-modifying therapy exposure trends in women with multiple sclerosis: A contemporary cohort study.

Authors:
Ai-Lan Nguyen Eva Kubala Havrdova Dana Horakova Guillermo Izquierdo Tomas Kalincik Anneke van der Walt Murat Terzi Raed Alroughani Pierre Duquette Marc Girard Alexandre Prat Cavit Boz Patrizia Sola Diana Ferraro Alessandra Lugaresi Jeannette Lechner-Scott Michael Barnett Francois Grand'Maison Pierre Grammond Cristina Ramo-Tello Recai Turkoglu Pamela McCombe Eugenio Pucci Maria Trojano Franco Granella Daniele Spitaleri Vincent Van Pesch Aysun Soysal Celia Oreja-Guevara Freek Verheul Steve Vucic Suzanne Hodgkinson Mark Slee Radek Ampapa Julie Prevost Jose Luis Sanchez Menoyo Olga Skibina Claudio Solaro Javier Olascoaga Cameron Shaw Klaus Gregaard Madsen Kerisha Naidoo Robert Hyde Helmut Butzkueven Vilija Jokubaitis

Mult Scler Relat Disord 2019 Feb 3;28:235-243. Epub 2019 Jan 3.

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia. Electronic address:

Background: Exposure to disease-modifying therapy (DMT) during early pregnancy in women with relapsing-remitting MS (RRMS) may be increasing.

Objective: To retrospectively determine incidence of pregnancy, DMT exposure and pregnancy outcomes in women with RRMS.

Methods: We identified all women with RRMS aged 15-45 years in the MSBase Registry between 2005-2016. Annualised pregnancy incidence rates were calculated using Poisson regression models. DMT exposures and pregnancy outcomes were assessed.

Results: Of 9,098 women meeting inclusion criteria, 1,178 (13%) women recorded 1,521 pregnancies. The annualised incidence rate of pregnancy was 0.042 (95% CI 0.040, 0.045). A total of 635 (42%) reported pregnancies were conceived on DMT, increasing from 27% in 2006 to 62% in 2016. The median duration of DMT exposure during pregnancy was 30 days (IQR: 9, 50). There were a higher number of induced abortions on FDA pregnancy class C/D drugs compared with pregnancy class B and no DMT (p = 0.010); but no differences in spontaneous abortions, term or preterm births.

Conclusions: We report low pregnancy incidence rates, with increasing number of pregnancies conceived on DMT over the past 12-years. The median duration of DMT exposure in pregnancy was relatively short at one month.

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http://dx.doi.org/10.1016/j.msard.2019.01.003DOI Listing
February 2019

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