Disease modifying therapy and pregnancy outcomes in multiple sclerosis: A systematic review and meta-analysis

Erum Khan; Yusuf Kagzi; Mahmoud Elkhooly; Swapnil Surpur; Sijin Wen; Kanika Sharma; Shitiz Sriwastava

doi:10.1016/j.jneuroim.2023.578178

Disease modifying therapy and pregnancy outcomes in multiple sclerosis: A systematic review and meta-analysis

J Neuroimmunol. 2023 Oct 15:383:578178. doi: 10.1016/j.jneuroim.2023.578178. Epub 2023 Aug 24.

Authors

Erum Khan¹, Yusuf Kagzi², Mahmoud Elkhooly³, Swapnil Surpur⁴, Sijin Wen⁵, Kanika Sharma⁶, Shitiz Sriwastava⁷

Affiliations

¹ Department of Neurology, University of Alabama at Birmingham, AL,USA.
² Mahatma Gandhi Memorial Medical College, Indore, India.
³ Department of Neurology, Wayne State University, Detroit, MI, USA; Department of Neurology, Southern Illinois University, Springfield, IL, USA; Department of Neuropsychiatry, Minia University, Egypt.
⁴ JN Medical College, Belgaum, India.
⁵ West Virginia Clinical Transitional Science, Morgantown, WV, USA.
⁶ Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA.
⁷ Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA. Electronic address: shitiz.k.sriwastava@uth.tmc.edu.

PMID: 37672841
DOI: 10.1016/j.jneuroim.2023.578178

Abstract

Objectives: To report pregnancy outcomes among multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs).

Methods: We performed a retrospective chart review of articles published from June 1996 to May 2023. Additional information was acquired from the drug registries of individual pharmaceutical companies. A comparison was also made with pregnancy data of the general population using the World Health Organization database. Summary analysis was achieved using R statistical software (v3.6), and the overall prevalence of outcomes was estimated using a random effects model.

Results: A meta-analysis of 44 studies was conducted. Dimethyl fumarate had the highest prevalence of premature births at 0.6667% (SD:0.5236-0.7845). The highest rates of stillbirths and infant deaths (perinatal and neonatal) were observed with interferons at 0.004% (SD:0.001-0.010) and 0.009% (SD:0.005-0.0015), respectively. Cladribine had the majority of ectopic pregnancies (0.0234%, SD:0.0041-1217), while natalizumab had the highest prevalence of spontaneous abortions (0.1177%, SD:0.0931-0.1477) and live birth defects (0.0755%, SD:0.0643-0.0943).None of the outcomes were significantly different from those of the general population (p > 0.05), except ectopic pregnancy and spontaneous abortion (p < 0.001), where the odds were 0.665 (0.061-0.886) and 0.537(0.003-0.786), respectively. The pooled prevalence of MS relapses was 221% for a single episode (SD:0.001-0.714), 0.075% for more than one episode (SD:0.006-0.167), and 0.141% for at least one episode requiring steroids (SD:0.073-0.206) none of these reached clinical significance.

Conclusion: Existing research suggests that DMT use in MS patients during pregnancy is generally considered safe. This study supports their utilization on a case-by-case basis. However, further primary research on this topic with clinical trials is warranted.

Keywords: Cladribine and pregnancy; Disease modifying therapy; Fingolimod and pregnancy; MS and pregnancy.

Publication types

Review