June 9, 2010 (San Antonio, Texas) — Postpartum administration of intravenous (IV) steroids significantly reduced the incidence of relapses in patients with multiple sclerosis (MS), according to research findings presented here at the Consortium of Multiple Sclerosis Centers 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis.
MS is prevalent in young women, noted Jose Avila, MD, a neurologist and a postdoctoral fellow in MS at the Baylor College of Medicine, Houston, Texas. Pregnancy exerts a protective effect against relapses, but they increase in frequency during the postpartum period. According to the researchers who presented the study, the estimated mean relapse rate during the first trimester of pregnancy is 0.5 ± 1.3 (standard deviation), increasing to 1.2 ± 2.0 during the first trimester after delivery.
Dr. Avila and colleagues conducted a retrospective analysis, including 50 patients with relapsing-remitting MS and 2 patients with secondary progressive MS who had experienced 1 or more pregnancies. Each pregnancy was considered an individual case. Examined data included MS type; number of relapses before, during, and after pregnancy (first, second, and third trimester postpartum); treatment history; breastfeeding duration; and postpartum IV steroid use.
Seven patients had at least 1 relapse during pregnancy. Of the 52 patients in the study, 39 received postpartum IV steroids (methylprednisolone, 1 g), and 13 did not. During the first postpartum trimester, 18% of patients who received IV steroids experienced relapses. The frequency of relapse was 46.2% in patients who did not receive steroids (P = .0448). In the second and third postpartum trimesters, relapse percentage was 25.6% among patients who received steroids and 23% in patients who did not.
"Other centers have done this using intravenous immunoglobulin, but it is more expensive and has other side effects," Dr. Avila, who presented the research at a poster session, told Medscape Neurology. "Our suggestion is to give 1 g methylprednisolone right after delivery," he added.
"This opens the door to the validity of giving methylprednisolone postpartum. The next question is, should we give it every month during the first 3 months? I think we're also going to see people looking at giving IV immunoglobulin immediately postpartum," James P. Simsarian, MD, director of the Multiple Sclerosis Program at the Neurology Center of Fairfax, Virginia, who attended the session, told Medscape Neurology. "[Postpartum treatment of MS patients] is something everyone should do, and eventually there will be protocols," Dr. Simsarian added.
The study did not receive commercial support. Dr. Avila and Dr. Simsarian have disclosed no relevant financial relationships.
Consortium of Multiple Sclerosis Centers (CMSC) 24th Annual Conference and the Third Joint Meeting of Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS): Abstract S06. Presented June 4, 2010.
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