DMTs reduce risk of multiple sclerosis relapse during reproductive therapy

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Edith Graham, MD, assistant professor of neurology, Feinberg School of Medicine, Northwestern University

In women with multiple sclerosis (MS) and clinically isolated syndrome (CIS), continuation of disease-modifying therapy (DMT) during assisted reproductive technologies (ART) appears to reduce the risk of relapse during this period from marked hormonal fluctuations and stressors, explained Edith L. Graham, MD, and her colleagues who shared their findings at the 2022 Forum of the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).

Previous studies on this topic show a variable range of relapse risk in MS patients on ART, Dr. Graham noted.

Largest cohort of contemporary women with MS to date

“An increased risk of relapses has been reported in patients with MS and IBS after undergoing ART,” she said. “However, reported increases in annualized relapse rate after IVF varied widely across case studies ranging from four to 32 subjects, from a sevenfold increase in one to no change in the other. continuation of DMT, a more recent clinical trend, has not been fully evaluated.

In the largest cohort of contemporary women with MS to date, Dr. Graham and colleagues assessed the risk of relapse after antiretroviral therapy and identified risk factors for an increased risk of relapse. Women with MS or IBS (aged 18-45) who underwent at least one ART cycle between 1 January 2010 and 14 September 2021 were identified by retrospective chart review.

Only 13.5% of patients experienced MS relapse after antiretroviral therapy

Most (78%) women in the study (mean age, 35 years; mean disease duration, 7.5 years) received antiretroviral therapy due to infertility or the need for genetic testing preimplantation therapy, while 22% chose treatment for fertility preservation, the researchers reported. . Of the 19 of 37 patients taking DMT before ART, 10 continued to take the drug throughout ovarian hyperstimulation.

In those who received DMT within 12 months prior to ART, treatment included glatiramer acetate (N=9), interferons (N=3), and dimethyl fumarate (N=1); three participants received B-cell depleting agents. Additionally, three patients received drugs in response to rebound after discontinuation. Of these, two received fingolimod and one received natalizumab.

Of all patients, 13.5% experienced relapses of MS within 12 months of antiretroviral therapy; in this group, none had been treated with DMTs in the previous 12 months, the researchers reported. Three of the relapses occurred within 3 months of ARV treatment, one within 6 months and one within 12 months.

For women on ART, those who did not receive DMT had a significantly higher risk of relapse than those who were treated with pharmacotherapy, Dr. Graham and colleagues noted. “The likelihood of achieving pregnancy with ART while having MS appeared favorable,” the researchers added.

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