Oral contraceptive use and clinical outcomes in patients with multiple sclerosis

• Published in: Journal of the neurological sciences 2012-06, Vol.317 (1), p.47-51
• Main Authors: Sena, Armando, Couderc, Rémy, Vasconcelos, Joana C, Ferret-Sena, Véronique, Pedrosa, Rui
• Format: Article
• Language: English
• Subjects: Adult; Benign; Biological and medical sciences; Cohort Studies; Contraceptives (oral); Contraceptives, Oral - administration & dosage; Cross-Sectional Studies; Data processing; Drugs; Female; Humans; Medical sciences; Multiple sclerosis; Multiple Sclerosis - drug therapy; Multiple Sclerosis - epidemiology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Multiple Sclerosis Severity Score (MSSS); Neurology; Neuroprotection; Oral contraceptives; Population studies; Prognosis; Regression analysis; Relapsing–remitting multiple sclerosis (RRMS); Retrospective Studies; Sex; Sex steroids; Smoking; Steroid hormones; Surveys and Questionnaires; Treatment Outcome; Young Adult
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2012.02.033

Abstract Experimental and clinical data suggest a role of sex steroids in the pathogenesis of multiple sclerosis (MS). Scant information is available about the potential effect of oral contraceptive (OC) use on the prognosis of the disease. We aimed to evaluate this. The study population consisted of 132 women with relapsing–remitting MS before receiving disease modifying treatment and a mean disease duration 6.2 (SD 5.1) years. Three groups of patients were distinguished according to their OC behavior: [1] never-users, patients who never used OC [2] past-users, patients who stopped OC use before disease onset, and [3] after-users, those who used these drugs after disease onset. Multiple linear and logistic regression models were used to analyze the association between oral contraceptive use and annualized relapse rates, disability accumulation and severity of the disease. After-user patients had lower Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Severity Score (MSSS) values than never users ( p < 0.001 and p = 0.002, respectively) and past users ( p = 0.010 and p = 0.002, respectively). These patients were also more likely to have a benign disease course (MSSS < 2.5) than never and past users together (OR: 4.52, 95%CI: 2.13–9.56, p < 0.001). This effect remained significant after adjustment for confounders, including smoking and childbirths (OR: 2.97, 95%CI: 1.24, 6.54, p = 0.011 and for MSSS β : − 1.04; 95% C.I. − 1.78, − 0.30, p = 0.006). These results suggest that OC use in women with relapsing–remitting MS is possible associated with a milder disabling disease course.