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. 2014 Winter;18(1):9-13.
doi: 10.7812/TPP/13-090.

Immunomodulatory agents and risk of postpartum multiple sclerosis relapses

Brandon Emet Beaber  1 , Margaret D Chi  2 , Sonu Malik Brara  3 , Jian Liang Zhang  4 , Annette M Langer-Gould  5
Affiliations

Immunomodulatory agents and risk of postpartum multiple sclerosis relapses

Brandon Emet Beaber et al. Perm J. 2014 Winter.

Abstract

Objective: To determine whether treatment with an interferon beta or glatiramer acetate shortly after delivery reduces the otherwise increased risk of postpartum relapses of multiple sclerosis.

Methods: In a retrospective cohort of 112 women with multiple sclerosis and live births from Kaiser Permanente Southern California, complete medical and pharmacy records of the mothers and infants were reviewed. Propensity score-adjusted hazard ratios (HR) of time to first postpartum relapse were calculated.

Results: Of 80 women who breastfed little or not at all, 55 (69%) resumed treatment within 1 year postpartum, of whom 26 (47%) relapsed within 6 months postpartum. Resuming treatment within 2 weeks postpartum did not decrease the risk of relapse in the 2 years postpartum compared with women who resumed treatment later in the postpartum year (propensity score-adjusted HR = 1.3, 95% confidence interval = 0.5-3.4, p = 0.6). There was no difference in relapse rates between the groups in the first 6 months postpartum. However, later in the postpartum year those who resumed treatment early had fewer relapses (p = 0.08, Poisson regression).

Conclusions: Among women who breastfeed little or not at all, starting treatment with interferon beta or glatiramer acetate within two weeks postpartum does not reduce the risk of postpartum relapse of multiple sclerosis but may reduce the risk of subsequent relapses in the postpartum year.

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Figures

Figure 1.
Figure 1.
Breastfeeding and treatment outcomes in women with multiple sclerosis included in the study. MS = multiple sclerosis; Tx = treatment.
Figure 2.
Figure 2.
Kaplan-Meier curve for multiple sclerosis relapses in the postpartum period among women who breastfed little or not at all and started immunomodulatory treatment within one postpartum year. Women who started treatment in the first 15 days (n = 17; dashed line) did not experience a delay in the time to the first postpartum relapse and had the same risk of having a postpartum relapse as women who started treatment later in the postpartum year (Days 16–365; n = 38; solid line; p value = 0.75 by log-rank test).
See this image and copyright information in PMC

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