Immunomodulation and postpartum relapses in patients with multiple sclerosis

Abstract

Multiple sclerosis (MS) mainly affects young women during a life period with desire for children. Relapse rate decreases during pregnancy and rises after delivery. Therefore, studies on satisfactory postpartum relapse prevention and its efficacy are essential. Previous smaller and uncontrolled studies suggested that intravenous immunoglobulin (IVIG) administration reduced the relapse rate following delivery. The objective of our observational study was to compare the efficacy of IVIG application, treatment with other immunomodulatory compounds or no treatment at all on the postpartal relapse rate in female MS patients from our pregnancy database. One hundred and twenty four pregnancies were followed in a partly prospective design. Relapse rate was reduced during pregnancy (p50.001) and increased during the initial 3 months after delivery in all MS patients (p50.001). The relapse rate reduction showed only a trend in favour of the IVIG-treated women, probably due to the small number of patients. However, analysing the expected number of relapses, IVIG treated patients had significantly less relapses postpartum than the untreated control group matched for disease activity before and during pregnancy ( 2 , p ¼ 0.013). The results suggest that IVIG could be an option to prevent postpartum relapse of MS.

Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy

“…A postpartum therapy with intravenous immunoglobulin as well reduced the number of relapses [62,90]. Moreover, in contrast to IFN-β or GA, breastfeeding is possible while receiving IVIG.…”

Human immunoglobulin G suppresses the production of matrix metalloproteinase‐9 in peripheral blood mononuclear cells of patients with multiple sclerosis

“…There have also been reports showing the efficacy of hIgG for relapse prevention and the attenuation of acute exacerbation . Finally, it is important to note that the safety of disease‐modifying therapies, such as IFN‐β, glatiramer acetate and fingolimod, has not been fully confirmed in pregnant or breastfeeding patients with RRMS . However, because of its safety, some investigators have gone ahead to recommended the use of hIgG therapy in this patient population .…”

Polyclonal immunoglobulin G for autoimmune demyelinating nervous system disorders

“…In agreement with a potential therapeutic benefit of IVIg in patients with RR MS, a placebo-controlled trial in 91 patients with a first clinical episode suggestive of MS demonstrated a significantly lower risk of conversion to clinically definite MS on repeated IVIg treatment (26%) compared to placebo (50%, P = 0.03) treatment after 1 year [184]. Preliminary evidence indicates that IVIg treatment, which is safe during breast-feeding, might reduce the generally increased post-partum relapse frequency [185][186][187]. Randomised placebo-controlled trials in pregnant and breast-feeding females with MS should further explore this special but important indication.…”