The Impact of Disease-modifying Therapy on Relapse Risk in Women with Multiple Sclerosis Undergoing Assisted Reproductive Technologies (ART)
Nele Range1, Sabrina Haben1, Sandra Thiel1, Ralf Gold1, Kerstin Hellwig1
1Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany
Objective:
To investigate the influence of ART on the relapse risk in women with multiple sclerosis (MS). To assess benefits of maintaining disease-modifying therapy (DMT) during ART.
Background:
Previous research reported an increased relapse risk after ART, newer studies lead to different conclusions. This study builds upon investigations by extending the cohort and focusing on the role of DMT in mitigating post-ART relapse risk.
Design/Methods:
Recruitment of women in an ART and MS sub-registry of the German Multiple Sclerosis and Pregnancy Registry (DMSKW) both prospectively and retrospectively. Telephone interviews with a standardized questionnaire gathered information on stimulations, pregnancy, disease course during and after ART. Poisson regression analyzed annualized relapse rates and relapse rate ratios, comparing the risk period three months post-ART versus the no risk period twelve months prior to ART or between stimulations.
Results:
126 women accounting for 344 stimulations with 229 (6.57%) under DMT (72.93% on first-line, 27.07% on second-line treatments). Relapses occured after 20/344 (5.81%) stimulations, fewer (7 (35%)) under DMTs versus 13 (65%) without DMT (p=0.005). Relapse rate ratios (RRR) were statistically significantly lower with the use of any DMT (RRR 0.18 [95% CI 0.08;0.42]), either first-line (0.51 [0.32;0.8] or second-line (0.15 [0.05;0.44]) during ART. Age, BMI, disease course, disease duration, stimulation protocol and ART outcome were not associated with the occurrence of relapses after ART. Of note pregnancy was not assicated with a reduced relapse risk ( 0.91 [0.47;1.77]).
Conclusions:
Relapse risk after ART was low and ART not associated with an increased relapse risk in this contemporary cohort. Maintaining DMTs (first and second-lines) during ART was the only modifiable factor associated with a reduction in relapse risk. The results are reassuring for women with MS who plan ART and are emphasizing the need for close disease management and counseling with pregnancy safe DMTS throughout the reproductive journey.