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Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients
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 reactivatio...
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| Published in: | Neurotherapeutics 2021-10, Vol.18 (4), p.2598-2607 |
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| creator | 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 |
| description | 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
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| doi_str_mv | 10.1007/s13311-021-01106-6 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8803993</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2624042318</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-e19e43a0d78cba6d2330456234a0982878ef5fc4796992b90fbc9af95b4a5b3e3</originalsourceid><addsrcrecordid>eNp9kU1rHDEMhk1pySab_IEeykDPk9iW58OXQMg3pHRJk2MwHq9m6zBrb23PQv59nU66bS89GBn0SK-kl5CPjB4zSpuTyAAYKynPjzFal_U7ss_api0b0cj3-S8ByoYzmJGDGJ8prQBku0dmIIQUHJp98nRhI-qIxT1qk-xWJ-tdofuEobiybuUHu_bLIlPGu2TdOAHWFYuAK6ddKr6MQ7KbAYtvZsDgo43FIlPoUjwkH3o9RDx6i3PyeHX5cH5T3n29vj0_uyuNaEQqkUkUoOmyaU2n6yUHoKKqOQhNZcvzRthXfWZlLSXvJO07I3Uvq07oqgOEOTmd-m7Gbo1Lk7WDHtQm2LUOL8prq_7NOPtdrfxWtS0Fma80J5_fGgT_Y8SY1LMfg8szK15zQfOxWJspPlEmrxkD9jsFRtWrJWqyRGVL1C9LVJ2LPv09267ktwcZgAmIOeVWGP5o_6ftT4BsmRo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2624042318</pqid></control><display><type>article</type><title>Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients</title><source>ScienceDirect Journals</source><source>Springer Nature</source><source>PubMed Central</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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
< 0.001 compared with the ARR before FTY treatment). Eleven patients became pregnant after a mean of 88 days following FTY discontinuation, whereas 16 patients stopped FTY after pregnancy confirmation. Relapses were observed in 22% of patients during pregnancy and in 44% in the postpartum period. ARR increased both during pregnancy (0.49; p = 0.027) and in the first year after delivery (0.67;
p
< 0.001) compared to the last year before pregnancy. Compared with radiological assessment before pregnancy, more patients showed new or enlarging T2 lesions (63% vs 30%;
p
= 0.02) and gadolinium-enhancing lesions (44% vs 0;
p
= 0.0001) on brain Magnetic Resonance Imaging. Relapses during pregnancy were the only significant predictor for postpartum relapses (OR 1.9, 95% CI 1.11–3.1). One case of spontaneous abortion and no cases of abnormal foetal development were observed. Despite adequate and prolonged control of disease activity, women who discontinue FTY because of pregnancy are at risk for disease reactivation. In patients who relapsed during pregnancy, the initiation of high-efficacy disease modifying drugs (DMDs) soon after delivery is advisable to prevent postpartum relapses.</description><identifier>ISSN: 1933-7213</identifier><identifier>ISSN: 1878-7479</identifier><identifier>EISSN: 1878-7479</identifier><identifier>DOI: 10.1007/s13311-021-01106-6</identifier><identifier>PMID: 34494237</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>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</subject><ispartof>Neurotherapeutics, 2021-10, Vol.18 (4), p.2598-2607</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-e19e43a0d78cba6d2330456234a0982878ef5fc4796992b90fbc9af95b4a5b3e3</citedby><cites>FETCH-LOGICAL-c474t-e19e43a0d78cba6d2330456234a0982878ef5fc4796992b90fbc9af95b4a5b3e3</cites><orcidid>0000-0002-7693-2256 ; 0000-0003-1181-1709 ; 0000-0003-1179-3299 ; 0000-0002-7527-575X ; 0000-0002-8390-8545 ; 0000-0002-4085-8170 ; 0000-0002-7101-0949 ; 0000-0002-0447-2297 ; 0000-0002-8763-4166 ; 0000-0001-5852-7743 ; 0000-0002-7783-114X ; 0000-0001-5013-0733</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803993/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803993/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,882,27906,27907,53773,53775</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34494237$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bianco, Assunta</creatorcontrib><creatorcontrib>Lucchini, Matteo</creatorcontrib><creatorcontrib>Totaro, Rocco</creatorcontrib><creatorcontrib>Fantozzi, Roberta</creatorcontrib><creatorcontrib>De Luca, Giovanna</creatorcontrib><creatorcontrib>Di Lemme, Sonia</creatorcontrib><creatorcontrib>Presicce, Giorgia</creatorcontrib><creatorcontrib>Evangelista, Luana</creatorcontrib><creatorcontrib>Di Tommaso, Valeria</creatorcontrib><creatorcontrib>Pastorino, Roberta</creatorcontrib><creatorcontrib>De Fino, Chiara</creatorcontrib><creatorcontrib>De Arcangelis, Valeria</creatorcontrib><creatorcontrib>Centonze, Diego</creatorcontrib><creatorcontrib>Mirabella, Massimiliano</creatorcontrib><title>Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients</title><title>Neurotherapeutics</title><addtitle>Neurotherapeutics</addtitle><addtitle>Neurotherapeutics</addtitle><description>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
< 0.001 compared with the ARR before FTY treatment). Eleven patients became pregnant after a mean of 88 days following FTY discontinuation, whereas 16 patients stopped FTY after pregnancy confirmation. Relapses were observed in 22% of patients during pregnancy and in 44% in the postpartum period. ARR increased both during pregnancy (0.49; p = 0.027) and in the first year after delivery (0.67;
p
< 0.001) compared to the last year before pregnancy. Compared with radiological assessment before pregnancy, more patients showed new or enlarging T2 lesions (63% vs 30%;
p
= 0.02) and gadolinium-enhancing lesions (44% vs 0;
p
= 0.0001) on brain Magnetic Resonance Imaging. Relapses during pregnancy were the only significant predictor for postpartum relapses (OR 1.9, 95% CI 1.11–3.1). One case of spontaneous abortion and no cases of abnormal foetal development were observed. Despite adequate and prolonged control of disease activity, women who discontinue FTY because of pregnancy are at risk for disease reactivation. In patients who relapsed during pregnancy, the initiation of high-efficacy disease modifying drugs (DMDs) soon after delivery is advisable to prevent postpartum relapses.</description><subject>Adult</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Breastfeeding & lactation</subject><subject>Drug delivery</subject><subject>Female</subject><subject>Fingolimod Hydrochloride - adverse effects</subject><subject>Gadolinium</subject><subject>Humans</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Magnetic resonance imaging</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - drug therapy</subject><subject>Multiple Sclerosis, Relapsing-Remitting - drug therapy</subject><subject>Neurobiology</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><subject>Postpartum</subject><subject>Pregnancy</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><issn>1933-7213</issn><issn>1878-7479</issn><issn>1878-7479</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU1rHDEMhk1pySab_IEeykDPk9iW58OXQMg3pHRJk2MwHq9m6zBrb23PQv59nU66bS89GBn0SK-kl5CPjB4zSpuTyAAYKynPjzFal_U7ss_api0b0cj3-S8ByoYzmJGDGJ8prQBku0dmIIQUHJp98nRhI-qIxT1qk-xWJ-tdofuEobiybuUHu_bLIlPGu2TdOAHWFYuAK6ddKr6MQ7KbAYtvZsDgo43FIlPoUjwkH3o9RDx6i3PyeHX5cH5T3n29vj0_uyuNaEQqkUkUoOmyaU2n6yUHoKKqOQhNZcvzRthXfWZlLSXvJO07I3Uvq07oqgOEOTmd-m7Gbo1Lk7WDHtQm2LUOL8prq_7NOPtdrfxWtS0Fma80J5_fGgT_Y8SY1LMfg8szK15zQfOxWJspPlEmrxkD9jsFRtWrJWqyRGVL1C9LVJ2LPv09267ktwcZgAmIOeVWGP5o_6ftT4BsmRo</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Bianco, Assunta</creator><creator>Lucchini, Matteo</creator><creator>Totaro, Rocco</creator><creator>Fantozzi, Roberta</creator><creator>De Luca, Giovanna</creator><creator>Di Lemme, Sonia</creator><creator>Presicce, Giorgia</creator><creator>Evangelista, Luana</creator><creator>Di Tommaso, Valeria</creator><creator>Pastorino, Roberta</creator><creator>De Fino, Chiara</creator><creator>De Arcangelis, Valeria</creator><creator>Centonze, Diego</creator><creator>Mirabella, Massimiliano</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7693-2256</orcidid><orcidid>https://orcid.org/0000-0003-1181-1709</orcidid><orcidid>https://orcid.org/0000-0003-1179-3299</orcidid><orcidid>https://orcid.org/0000-0002-7527-575X</orcidid><orcidid>https://orcid.org/0000-0002-8390-8545</orcidid><orcidid>https://orcid.org/0000-0002-4085-8170</orcidid><orcidid>https://orcid.org/0000-0002-7101-0949</orcidid><orcidid>https://orcid.org/0000-0002-0447-2297</orcidid><orcidid>https://orcid.org/0000-0002-8763-4166</orcidid><orcidid>https://orcid.org/0000-0001-5852-7743</orcidid><orcidid>https://orcid.org/0000-0002-7783-114X</orcidid><orcidid>https://orcid.org/0000-0001-5013-0733</orcidid></search><sort><creationdate>20211001</creationdate><title>Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-e19e43a0d78cba6d2330456234a0982878ef5fc4796992b90fbc9af95b4a5b3e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Breastfeeding & lactation</topic><topic>Drug delivery</topic><topic>Female</topic><topic>Fingolimod Hydrochloride - adverse effects</topic><topic>Gadolinium</topic><topic>Humans</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Magnetic resonance imaging</topic><topic>Multiple sclerosis</topic><topic>Multiple Sclerosis - drug therapy</topic><topic>Multiple Sclerosis, Relapsing-Remitting - drug therapy</topic><topic>Neurobiology</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><topic>Postpartum</topic><topic>Pregnancy</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bianco, Assunta</creatorcontrib><creatorcontrib>Lucchini, Matteo</creatorcontrib><creatorcontrib>Totaro, Rocco</creatorcontrib><creatorcontrib>Fantozzi, Roberta</creatorcontrib><creatorcontrib>De Luca, Giovanna</creatorcontrib><creatorcontrib>Di Lemme, Sonia</creatorcontrib><creatorcontrib>Presicce, Giorgia</creatorcontrib><creatorcontrib>Evangelista, Luana</creatorcontrib><creatorcontrib>Di Tommaso, Valeria</creatorcontrib><creatorcontrib>Pastorino, Roberta</creatorcontrib><creatorcontrib>De Fino, Chiara</creatorcontrib><creatorcontrib>De Arcangelis, Valeria</creatorcontrib><creatorcontrib>Centonze, Diego</creatorcontrib><creatorcontrib>Mirabella, Massimiliano</creatorcontrib><collection>SpringerOpen (Open Access)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Psychology Journals</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurotherapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bianco, Assunta</au><au>Lucchini, Matteo</au><au>Totaro, Rocco</au><au>Fantozzi, Roberta</au><au>De Luca, Giovanna</au><au>Di Lemme, Sonia</au><au>Presicce, Giorgia</au><au>Evangelista, Luana</au><au>Di Tommaso, Valeria</au><au>Pastorino, Roberta</au><au>De Fino, Chiara</au><au>De Arcangelis, Valeria</au><au>Centonze, Diego</au><au>Mirabella, Massimiliano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients</atitle><jtitle>Neurotherapeutics</jtitle><stitle>Neurotherapeutics</stitle><addtitle>Neurotherapeutics</addtitle><date>2021-10-01</date><risdate>2021</risdate><volume>18</volume><issue>4</issue><spage>2598</spage><epage>2607</epage><pages>2598-2607</pages><issn>1933-7213</issn><issn>1878-7479</issn><eissn>1878-7479</eissn><abstract>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
< 0.001 compared with the ARR before FTY treatment). Eleven patients became pregnant after a mean of 88 days following FTY discontinuation, whereas 16 patients stopped FTY after pregnancy confirmation. Relapses were observed in 22% of patients during pregnancy and in 44% in the postpartum period. ARR increased both during pregnancy (0.49; p = 0.027) and in the first year after delivery (0.67;
p
< 0.001) compared to the last year before pregnancy. Compared with radiological assessment before pregnancy, more patients showed new or enlarging T2 lesions (63% vs 30%;
p
= 0.02) and gadolinium-enhancing lesions (44% vs 0;
p
= 0.0001) on brain Magnetic Resonance Imaging. Relapses during pregnancy were the only significant predictor for postpartum relapses (OR 1.9, 95% CI 1.11–3.1). One case of spontaneous abortion and no cases of abnormal foetal development were observed. Despite adequate and prolonged control of disease activity, women who discontinue FTY because of pregnancy are at risk for disease reactivation. In patients who relapsed during pregnancy, the initiation of high-efficacy disease modifying drugs (DMDs) soon after delivery is advisable to prevent postpartum relapses.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>34494237</pmid><doi>10.1007/s13311-021-01106-6</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7693-2256</orcidid><orcidid>https://orcid.org/0000-0003-1181-1709</orcidid><orcidid>https://orcid.org/0000-0003-1179-3299</orcidid><orcidid>https://orcid.org/0000-0002-7527-575X</orcidid><orcidid>https://orcid.org/0000-0002-8390-8545</orcidid><orcidid>https://orcid.org/0000-0002-4085-8170</orcidid><orcidid>https://orcid.org/0000-0002-7101-0949</orcidid><orcidid>https://orcid.org/0000-0002-0447-2297</orcidid><orcidid>https://orcid.org/0000-0002-8763-4166</orcidid><orcidid>https://orcid.org/0000-0001-5852-7743</orcidid><orcidid>https://orcid.org/0000-0002-7783-114X</orcidid><orcidid>https://orcid.org/0000-0001-5013-0733</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1933-7213 |
| ispartof | Neurotherapeutics, 2021-10, Vol.18 (4), p.2598-2607 |
| issn | 1933-7213 1878-7479 1878-7479 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8803993 |
| source | ScienceDirect Journals; Springer Nature; PubMed Central |
| 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 |
| title | Disease Reactivation after Fingolimod Discontinuation in Pregnant Multiple Sclerosis Patients |
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