Neurology Department, CRCSEP, Rennes Clinical Investigation Centre CIC-P 1414, Service de Neurologie, CHU Pontchaillou, Rennes University Hospital Rennes University INSERM, Rennes 35033, France.
EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, University Rennes, Rennes F-35000, France.
Mult Scler Relat Disord. 2022 Dec;68:104122. doi: 10.1016/j.msard.2022.104122. Epub 2022 Aug 15.
In Multiple Sclerosis (MS) women, therapeutic management for pregnancy planning and during pregnancy still represents a challenge regarding timing of disease-modifying therapies (DMT) stop, risk of disease reactivation and potential fetal toxicity. The objective of this study was to describe disease activity during pregnancy and postpartum depending on treatment status before conception in women with MS.
339 MS patients who have achieved a pregnancy between 2007 and 2017 were included. Women were classified according to their exposure to DMT in the 18 months period prior to pregnancy (untreated / first- / second/third-line treatment).
122 women were not exposed to DMT prior to conception, whereas 147 were exposed to first-line DMT and 70 to second/third line DMT (73% to natalizumab and 23% to fingolimod) before conception. In the first-line group, the ARR decreased from 0.39 during the year before conception to 0.21 during pregnancy, whereas it increased in the second/third-line group from 0.59 to 0.78. 47.1% of the second/third-line group faced at least one relapse during pregnancy and the time from conception to first relapse was significantly shorter in this group (p < 10). The risk of relapse during pregnancy and postpartum was associated with occurrence of pre-conception relapses and second/third line DMT exposure before pregnancy.
Careful consideration should be given to natalizumab and fingolimod exposed patients before conception as they are at higher risk of reactivation of MS during pregnancy.
在多发性硬化症（MS）女性中，妊娠计划和怀孕期间的治疗管理仍然是一个挑战，涉及疾病修正治疗（DMT）停止的时机、疾病复发的风险和潜在的胎儿毒性。本研究的目的是描述在 MS 女性中，根据受孕前的治疗状况，描述妊娠和产后期间的疾病活动情况。
纳入了 339 名在 2007 年至 2017 年期间实现妊娠的 MS 患者。根据受孕前 18 个月期间的 DMT 暴露情况（未治疗/一线/二线/三线治疗）对女性进行分类。
122 名女性受孕前未暴露于 DMT，而 147 名女性暴露于一线 DMT，70 名女性暴露于二线/三线 DMT（73%为那他珠单抗，23%为芬戈莫德）。在一线治疗组中，ARR 从受孕前一年的 0.39 降至妊娠期间的 0.21，而在二线/三线治疗组中从 0.59 增至 0.78。二线/三线治疗组中有 47.1%的患者至少经历了一次妊娠期间的复发，且该组从受孕到首次复发的时间明显缩短（p < 10）。妊娠和产后期间复发的风险与受孕前的复发以及受孕前的二线/三线 DMT 暴露有关。
在考虑受孕前应慎重考虑那他珠单抗和芬戈莫德暴露的患者，因为他们在妊娠期间 MS 复发的风险更高。
