Postpartum Relapse Patterns Among Multiple Sclerosis Patients with Exposure to Disease Modifying Therapy Before or During Pregnancy
Riley Bove1, Angela Applebee2, Katrina Bawden3, Celeste Fine4, Anna Shah5, Robin Avila6, Nicholas Belviso6, Filipe Branco6, Kinyee Fong6, James Lewin6, Jieruo Liu6, Sarah England6, Megan Vignos6
1Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, 2Department of Neurology, St. Peter’s MS and Headache Center, 3Rocky Mountain MS Clinic, 4Gilbert Neurology, 5University of Colorado, Rocky Mountain MS Center, 6Biogen Inc.
Objective:
To describe relapse patterns during pregnancy and postpartum among patients with disease modifying therapy (DMT) exposure during pregnancy in two large claims databases.
Background:
A large proportion of women with multiple sclerosis (MS) are of childbearing age, and evolving guidance is needed regarding how to optimize management of the pregnancy and postpartum periods in light of the changing DMT landscape.
Design/Methods:
This retrospective, observational study used data from the US MarketScan Commercial and Medicaid claims databases. Female patients analyzed had ≥1 insurance claim submitted under the diagnosis code of MS from 01/01/2016-04/30/2021 and continuous enrollment eligibility from ≥6 month prior to pregnancy date (pre-pregnancy) through 6 months of follow-up following delivery (postpartum period). Moderate/severe relapse was defined as MS-related hospitalization or an outpatient visit and 1 claim within 7 days of the visit with steroids or total plasma exchange.
Results:
A total of 944 patients (mean [SD] age, 32.4 [5.0] years) were eligible (commercial, n=688; Medicaid n=256). Overall, the proportion of patients with any moderate/severe relapse declined over pregnancy (from pre-pregnancy, n=82 [8.7%]; trimester [T] 1, n=11 [1.2%]; T2, n=8 [0.9%]; T3, n=10 [1.1%]) but increased postpartum. More relapses were experienced 0-3 months postpartum (n=61 [6.5%]) compared to 4-6 months postpartum (n=51 [5.4%]). Of the 889 patients who stopped DMT for pregnancy, the risk of postpartum relapses was lower in the women who resumed DMT postpartum (10/192) than in patients who did not, (76/697) (5.2% vs. 10.9%, p=0.018).
Conclusions:
The proportion of patients with MS experiencing a moderate/severe relapse and number of relapses declined over pregnancy but increased postpartum. Reinitiation of DMT during the postpartum period was associated with lower risk of relapses. Current findings support a role for early reinitiation of DMT postpartum.