Menascu Shay, Siegel-Kirshenbaum Michal, Dreyer-Alster Sapir, Warszawer Yehuda, Magalashvili David, Dolev Mark, Mandel Mathilda, Harari Gil, Achiron Anat
Multiple Sclerosis Center, Sheba Medical Center, Ramat-Gann, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Mult Scler J Exp Transl Clin. 2023 Jan 17;9(1):20552173221151127. doi: 10.1177/20552173221151127. eCollection 2023 Jan-Mar.
Relapsing-remitting multiple sclerosis (RRMS) affects predominantly young women within reproductive years. As an increased risk of relapses is known to occur during the post-partum period, it is important to consider treatment options.
Evaluate the effects of intravenous immunoglobulins (IVIg) to prevent post-partum relapses.
We prospectively followed 198 pregnant female RRMS patients, 67 treated with IVIg during pregnancy and the three months post-partum, and 131 untreated patients that served as controls.
During the pre-gestation year, 41.4% were treated with immunomodulatory drugs, and 28.3% experienced a relapse. During pregnancy and the post-partum period, the number of relapsing patients significantly decreased in the IVIg group (37.3%, 10.4%, 8.9%, respectively, = 0.0003), while no significant change was observed in the untreated group (23.7%, 17.6%, and 22.1%). During the three-month post-partum period, there were only mild and moderate relapses in the IVIg group, while in the untreated group, there were also severe relapses. Stepwise logistic regression that assessed the relation between three-month post-partum relapse and explanatory variables demonstrated that untreated patients had increased risk for post-partum relapse (odds ratio = 4.6, 95% CI [1.69, 12.78], = 0.033).
IVIg treatment proved efficient to reduce the rate and severity of relapses during pregnancy and the three-month post-partum.
复发缓解型多发性硬化症（RRMS）主要影响处于生育年龄的年轻女性。由于已知产后复发风险会增加，因此考虑治疗方案很重要。
评估静脉注射免疫球蛋白（IVIg）预防产后复发的效果。
我们前瞻性地跟踪了198名怀孕的RRMS女性患者，其中67名在孕期及产后三个月接受了IVIg治疗，131名未治疗的患者作为对照。
在妊娠前一年，41.4%的患者接受了免疫调节药物治疗，28.3%的患者经历了复发。在孕期和产后期间，IVIg组复发患者数量显著减少（分别为37.3%、10.4%、8.9%，P = 0.0003），而未治疗组未观察到显著变化（分别为23.7%、17.6%和22.1%）。在产后三个月期间，IVIg组仅有轻度和中度复发，而未治疗组也有严重复发。评估产后三个月复发与解释变量之间关系的逐步逻辑回归表明，未治疗患者产后复发风险增加（优势比 = 4.6，95%置信区间[1.69, 12.78]，P = 0.033）。
IVIg治疗被证明可有效降低孕期及产后三个月的复发率和严重程度。
