Pregnancy effect on disease activity in women with multiple sclerosis treated with cladribine

• Published in: Journal of neurology 2024-07, Vol.271 (7), p.4039-4045
• Main Authors: Signoriello, E., Foschi, M., Lanzillo, R., Frau, J., Cocco, E., Borriello, G., Ianniello, A., Trotta, M., Landi, D., Maniscalco, G. T., Ruscica, F., Toscano, S., Patti, F., Zanghì, A., D’Amico, E., Fantozzi, R., Centonze, D., Lus, G., Bonavita, S.
• Format: Article
• Language: English
• Subjects: Adult; Cladribine; Cladribine - administration & dosage; Cladribine - pharmacology; Demography; Disability Evaluation; Female; Follow-Up Studies; Humans; Immune reconstitution; Immunosuppressive Agents - therapeutic use; Medicine; Medicine & Public Health; Multiple sclerosis; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Neurology; Neuroradiology; Neurosciences; Original Communication; Pregnancy; Pregnancy Complications - drug therapy; Womens health; Young Adult
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-024-12291-7

Introduction C ladribine is an oral immune reconstitution therapy for relapsing multiple sclerosis (RMS). Hormonal and immune changes are responsible for the decline of disease activity in the third trimester of pregnancy and disease reactivation in the early post-partum period.We investigate the impact of pregnancy on disease activity in women with MS who conceived after cladribine treatment. Methods We recruited women of childbearing age with relapsing–remitting MS (RRMS) who became pregnant or not after being treated with cladribine. For both groups, demographic, clinical and radiological data were collected 1 year before and after treatment during a mean follow-up of 3.53 years. We compared disease activity over time between groups using variance analysis for repeated measures. Results 48 childbearing women were included. 25 women had a pregnancy after a mean of 1.75 years from the first treatment cycle. Women with or without pregnancy did not differ in demographics or pre-cladribine disease activity. No significant differences in disease activity or EDSS worsening were found between women with or without pregnancy. Discussion Our findings suggest that pregnancy does not appear to influence disease activity and disability in women previously treated with cladribine; further studies with larger numbers and longer follow-up are needed to confirm this finding.