Oral contraceptives and MS disease activity in a contemporary real-world cohort

Bove, Riley; Rankin, Kelsey A; Chua, Alicia; Saraceno, Taylor; Sattarnezhad, Neda; Greeke, Emily; Stuart, Fiona; LaRussa, Allison; Glanz, Bonnie I.; Chitnis, Tanuja

doi:10.1177/1352458517692420

Cited by 18 publications

(17 citation statements)

References 15 publications

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“…However, in individuals carrying the major E3/E3 phenotype, EDSS and MSSS were significant lower in the OC+ group, when compared to OC– patients. In line with previous retrospective work (6, 7) and a recent longitudinal study (22) no influence of OC use on relapse risk was observed. Future research in a larger population of carriers of the ε2 and ε4 alleles is needed.…”

Section: Discussionsupporting

confidence: 90%

Serum Lipoprotein Profile Is Associated With Protective Effects of Oral Contraceptive Use on Multiple Sclerosis Severity: A Cross-Sectional Study

et al. 2019

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Background: The mechanisms underlying the influence of sex hormones in multiple sclerosis (MS) are uncertain. Sex steroids interact with cholesterol metabolism and the serum lipid profile has been associated with the severity of the disease. We hypothesized that the putative associations between lipoprotein metabolism and MS could be modulated by sex steroids exposure. The aim of this study was to investigate whether oral contraceptives (OC) use changes the lipoprotein profile associated with disability in patients with multiple sclerosis.Methods: Clinical data was collected from 133 relapsing-remitting multiple sclerosis (RRMS) women with a mean of 6.5 years of disease duration and prior to the start of disease-modifying therapies. Patients who were using OC after disease onset (DO) (OC+, n = 57) were compared to those who never used OC or discontinued its intake before DO (OC–, n = 76). In both cohorts of subjects, the associations between the apolipoprotein E (ApoE) polymorphism, and plasma lipid levels, and the annualized relapse rate (RR), the Expanded Disability Status Score (EDSS), and the Multiple Sclerosis Severity Score (MSSS) were evaluated using a hierarchic multiple regression analysis after adjustment for confounders.Results: Low density lipoprotein (LDL) levels were associated with higher EDSS (p = 0.010) and MSSS (p = 0.024) in the whole studied cohort. In E3/E3 phenotype carriers (73.7%), EDSS and MSSS were lower in OC+ in comparison with OC– subgroup of patients (p < 0.01). LDL and total cholesterol were associated with EDSS (p = 0.005 and p = 0.043, respectively), and LDL and the triglyceride/high density lipoprotein ratio with MSSS (p = 0.011 and p = 0.048, respectively) in OC+ patients. In OC– subgroup of patients, ApoE levels were associated with EDSS (p = 0.012) and MSSS (p = 0.031). No significant interactions between the lipid variables or OC use and RR were observed.Conclusions: Serum lipid profile is associated with protective effects of OC use on disability of RRMS patients. Lipoprotein metabolism may be involved in the modulatory effects of sex steroids on the severity of the disease.

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Section: Discussionsupporting

confidence: 90%

Serum Lipoprotein Profile Is Associated With Protective Effects of Oral Contraceptive Use on Multiple Sclerosis Severity: A Cross-Sectional Study

et al. 2019

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“…DMTs do not appear to decrease the effectiveness of hormonal contraception although formal drug-drug interaction studies are limited [29]. Some studies have demonstrated that the use of oral contraceptives (OC) does not affect the disease course [30,31]. In a Portuguese cohort of 132 women a lower EDSS and milder disease severity measured by the Multiple Sclerosis Severity Score (MSSS) were found in women who used OC after disease onset (41%) compared with neverusers and past-users (discontinued OC before onset) [32].…”

Section: Use Of Contraceptivesmentioning

confidence: 99%

Pharmacotherapeutic considerations in women with multiple sclerosis

Andersen

Magyari

2020

Expert Opinion on Pharmacotherapy

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Introduction: Multiple sclerosis (MS) is a chronically progressive disease of the central nervous system. The relapsing form of the disease predominantly affects women with onset between the ages 20 to 40 years. Therefore, timing, choice, and treatment options should take pregnancy planning into consideration to accommodate both the needs and safety of the mother and health of the fetus. Areas covered: In this review, the authors discuss and summarize the recent evidence of different pharmacotherapeutic possibilities in the treatment of women with MS. Expert opinion: There is evidence that disease modifying therapy reduces the risk of relapses and diminishes disability progression in people with relapsing MS. The disease is often diagnosed in the childbearing years, and thus pregnancy planning can possibly be a part of the pharmacotherapeutic considerations. The management of women planning pregnancy requires a balancing of risks. The clinician must consider the risks related to treatment discontinuation versus the risk of exposing the developing fetus to drugs that are potential fetotoxic. Randomized controlled trials of medication safety-if used during pregnancy, are prohibited for ethical reasons; hence, the evidence is continuously gathered from observational data, post-authorization studies and pregnancy registries.

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“…In experimental autoimmune encephalomyelitis (EAE) models, administration of estriol improved EAE, which correlated with a decrease in the number of CNS inflammatory cells [8]. However, retrospective and prospective studies have reported mixed results regarding oral contraceptive (OC) use and MS risk [10,11,12] and have reported a positive influence on relapse rates [13]. While Hellwig et al found that OC use was associated with a slightly increased risk of MS/clinically isolated syndrome (CIS) (adjusted odds ratio (OR) = 1.52, 95% CI = 1.21–1.91; p < 0.001) [12], the risk did not change with duration of OC use, suggesting non-causal association.…”

Section: Pre-pregnancymentioning

confidence: 99%

“…Additionally, age of MS onset increased with increasing time of OC use prior to MS onset [10]. Bove et al evaluated effects of past-, current- or never-OC use in women with new onset relapsing remitting multiple sclerosis (RRMS) or CIS started on a first-line injectable disease-modifying therapy and found that past OC users had a statistically significant lower annualized relapse rate (ARR) compared to never OC users (Relative Risk (RR) = 0.64, p = 0.031) and that current OC users had a non-statistically significant lower ARR compared to never OC users (RR = 0.97, p = 0.91) [13].…”

Section: Pre-pregnancymentioning

confidence: 99%

“…DMT-specific recommendations for contraceptive use are included in Table 1 [15,16,17,18,19,20], if provided specifically in the prescribing recommendations. Beyond the need for pregnancy protection while using DMT, oral contraceptive use is considered safe in MS [13], and potential additional benefits on disease activity may be seen with oral contraceptive use in combination with platform injectable therapy [9,14].…”

Section: Pre-pregnancymentioning

confidence: 99%

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Women’s Health: Contemporary Management of MS in Pregnancy and Post-Partum

Tisovic

Amezcua

2019

Biomedicines

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Multiple sclerosis (MS) primarily affects women in childbearing age and is associated with an increased risk of adverse post-partum outcomes. Relapses and now fetal exposure to disease modifying treatments in the early phase of pregnancy and thereafter are of concern. Safe and effective contraception is required for women who wish to delay or avoid pregnancy while on disease-modifying treatments. Counseling and planning is essential to assess the risk of both fetal and maternal complications, particularly now in the era of highly efficient and riskier therapies. The purpose of this review is to provide a practical framework using the available data surrounding pregnancy in MS with the goal of optimizing outcomes during this phase in MS.

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Oral contraceptives and MS disease activity in a contemporary real-world cohort

Abstract: These observations provide reassurance for women newly diagnosed that OC use, past or current, does not appear to be associated with greater risk of relapses.

Cited by 18 publications

References 15 publications

Serum Lipoprotein Profile Is Associated With Protective Effects of Oral Contraceptive Use on Multiple Sclerosis Severity: A Cross-Sectional Study

Serum Lipoprotein Profile Is Associated With Protective Effects of Oral Contraceptive Use on Multiple Sclerosis Severity: A Cross-Sectional Study

Pharmacotherapeutic considerations in women with multiple sclerosis

Women’s Health: Contemporary Management of MS in Pregnancy and Post-Partum

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