Change in pregnancy-associated multiple sclerosis relapse rates over time: a meta-analysis

Multiple Sclerosis and Related Disorders
Ruth DobsonGavin Giovannoni

Abstract

Women with MS are advised that relapse rates fall during pregnancy and rebound post-partum. This advice originates from 1998; smaller, more recent, studies have not been previously pooled. All studies published since 1998 providing raw relapse data were considered for inclusion. Single arm meta-analysis was performed using a restricted maximum likelihood random effects model with inverse variance; secondary subgroup analysis and meta regression were then performed. Annualised relapse rates (ARR), or relapse numbers/rates suitable for conversion into ARR during pregnancy and the post-partum period were included. Secondary subgroup analysis examined year of data collection, DMT exposure, breastfeeding and data source. 7034 pregnancies from 6430 women were included. ARR fell from 0.57 (95%CI 0.45-0.70) pre-pregnancy to 0.36 (0.28-0.44), 0.29 (0.21-0.36) and 0.16 (0.11-0.21) during trimesters 1,2, and 3, with a post-partum rebound (ARR 0.85, 95%CI 0.70-1.00). ARR reduced pre-pregnancy and post-partum over time (p<0.001). Relapse rates were lower in claims databases than elsewhere. Despite high heterogeneity, we confirm the historic assumption that ARR reduces during pregnancy, and demonstrate an overall reduction in ARR over time. ...Continue Reading

References

Mar 16, 2011·BJOG : an International Journal of Obstetrics and Gynaecology·A FinkelsztejnY D Fragoso
Nov 22, 2014·Obstetrics and Gynecology·Riley BoveA Dessa Sadovnick
Nov 5, 2016·Journal of Neurology, Neurosurgery, and Psychiatry·Chunrong TaoUNKNOWN MSBase Study Group
Sep 24, 2018·Practical Neurology·Floriana De AngelisS Anand Trip
Feb 23, 2019·Multiple Sclerosis : Clinical and Laboratory Research·Emilio Portaccio, Maria Pia Amato
Mar 29, 2019·The Medical Journal of Australia·Anneke Van Der WaltVilija Jokubaitis

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Citations

Feb 24, 2021·JAMA : the Journal of the American Medical Association·Marisa P McGinleyAlexander D Rae-Grant
May 1, 2021·Multiple Sclerosis : Clinical and Laboratory Research·Chris HollenVijayshree Yadav
Mar 13, 2021·Current Opinion in Neurology·Ruth Dobson, Kerstin Hellwig
Jun 11, 2021·Scientific Reports·Malou JanssenMarvin M van Luijn
Jun 17, 2021·Multiple Sclerosis : Clinical and Laboratory Research·Emilio PortaccioUNKNOWN MS Study Group of the Italian Neurological Society

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