Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco (UCSF), San Francisco, CA, USA.
Mult Scler. 2020 Oct;26(11):1410-1419. doi: 10.1177/1352458519865118. Epub 2019 Aug 1.
Five case series reported increased relapse risk after assisted reproductive technologies (ART) in women with multiple sclerosis (MS), but small numbers and heterogeneous study design limit broader conclusions.
To evaluate the risk of relapses after ART in an independent case series and in aggregated analyses of existing studies.
We compared annualized relapse rate (ARR) in the 3 months after, and 12 months before, ART in (1) an unpublished cohort (Boston: prospectively collected relapses; 22 ART cycles), (2i) data pooled from Boston and five published studies (164 cycles), and (2ii) a meta-analysis of all case series published by 2017 (220 cycles; PRISMA and MOOSE guidelines).
In the Boston cohort, mean ARR was not higher after ART than before (mean: 0.18 ± 0.85 vs 0.27 ± 0.55, = 0.58). In the pooled analyses, ARR was significantly higher after ART for all clinical scenarios, including varying ART protocols ( ⩽ 0.01 for each). The meta-analysis confirmed an increased ARR after ART (mean difference (MD) = 0.92, 95% confidence interval (CI) = [0.33, 1.51], = 0.01).
These pooled data support an increase in ARR following ART. Reasons for local variation in ARR after ART, and consideration of MS treatments during conception attempts, will be pursued.
五项病例系列研究报告称，多发性硬化症（MS）女性在接受辅助生殖技术（ART）后复发风险增加，但由于病例数量少且研究设计存在异质性，无法得出更广泛的结论。
评估在独立病例系列和现有研究的汇总分析中 ART 后复发的风险。
我们比较了（1）未发表队列（波士顿：前瞻性收集的复发；22 个 ART 周期）、（2i）从波士顿和五项已发表研究中汇总的数据（164 个周期）以及（2ii）2017 年之前发表的所有病例系列的荟萃分析（220 个周期；PRISMA 和 MOOSE 指南）中 ART 后 3 个月和 12 个月前的年复发率（ARR）。
在波士顿队列中，ART 后平均 ARR 并不高于 ART 前（平均值：0.18±0.85 与 0.27±0.55， = 0.58）。在汇总分析中，对于所有临床情况，包括不同的 ART 方案，ART 后 ARR 均显著升高（每种情况均 ⩽ 0.01）。荟萃分析证实 ART 后 ARR 增加（平均差异（MD）=0.92，95%置信区间（CI）=[0.33, 1.51]， = 0.01）。
这些汇总数据支持 ART 后 ARR 增加。将进一步探讨 ART 后 ARR 局部变化的原因以及在受孕尝试期间考虑 MS 治疗的问题。
