Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients

• Published in: Neurotherapeutics 2021-10, Vol.18 (4), p.2598-2607
• Main Authors: Bianco, Assunta, Lucchini, Matteo, Totaro, Rocco, Fantozzi, Roberta, De Luca, Giovanna, Di Lemme, Sonia, Presicce, Giorgia, Evangelista, Luana, Di Tommaso, Valeria, Pastorino, Roberta, De Fino, Chiara, De Arcangelis, Valeria, Centonze, Diego, Mirabella, Massimiliano
• Format: Article
• Language: English
• Subjects: Adult; Biomedical and Life Sciences; Biomedicine; Breastfeeding & lactation; Drug delivery; Female; Fingolimod Hydrochloride - adverse effects; Gadolinium; Humans; Immunosuppressive Agents - adverse effects; Magnetic resonance imaging; Multiple sclerosis; Multiple Sclerosis - drug therapy; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Neurobiology; Neuroimaging; Neurology; Neurosciences; Neurosurgery; Original; Original Article; Patients; Postpartum; Pregnancy; Recurrence; Retrospective Studies
• ISSN: 1933-7213; 1878-7479; 1878-7479
• DOI: 10.1007/s13311-021-01106-6

Recent studies estimated an incidence of 4–25% of disease rebound after withdrawal of fingolimod (FTY) for any reason, but specific data on disease reactivation after FTY withdrawal due to pregnancy are limited. The aim of the study was to evaluate the frequency and predictors of disease reactivation in patients who stopped FTY for pregnancy. A multicentre retrospective cohort study was conducted in four Italian MS centres in 2013–2019. Both planned and unplanned pregnancies were included. The annualized relapse rate (ARR) was calculated before FTY treatment, during FTY treatment, during pregnancy and during the year after delivery. In total, 27 patients (mean age 29 years) were included. The ARR 1 year before FTY treatment was 1.3. Patients were exposed to FTY for a median of 2.9 years. The ARR was 0.04 during the last year before conception ( p