Posts Tagged 'MS'

Expecting the Best in Pregnancy and MS

 Pavle Repovic, MD, Ph.D, Neurologist, Multiple Sclerosis, Swedish Neuroscience Institute

Considering that multiple sclerosis (MS) affects primarily women of childbearing age, it comes as no surprise that for many patients MS and pregnancy often occur together. The issues to consider when discussing pregnancy and MS include:

• How pregnancy affects MS

• How MS affects pregnancy

• How MS treatment should be managed throughout pregnancy

The Pregnancy in MS (PRIMS) study of 254 patients revealed that pregnancy is generally protective against MS relapses, in particular during the third trimester. In contrast, the same study found a rebound of relapses during three months post delivery, with 30 percent of women experiencing a relapse within three months after delivery. Several strategies have been proposed to avert the risk of postpartum relapse, including the use of prophylactic IVIG or corticosteroids. More recently, exclusive breast-feeding has been found to offer some protection against postpartum MS activity; however, this finding was disputed in a subsequent study.

There is no evidence that MS impairs fertility or leads to an increased number of spontaneous abortions, stillbirths or congenital malformations. MS also does not increase a woman’s risk of preeclampsia or premature rupture of membranes. Pregnant women with MS are 1.3 times more likely to undergo antenatal hospitalization and to have a Cesarean delivery, and they are 1.7 times more likely to have infants who are small for gestational age 6.

Except for glatiramer acetate, all MS disease-modifying treatments (DMT) have documented in utero harmful effects in animal studies and are therefore FDA pregnancy category C agents. Glatiramer acetate is a category B agent and is not known to have harmful effects in animal studies, although human studies are lacking.

For these reasons, the National MS Society and most MS specialists advise women who intend to become pregnant to discontinue therapy. Given their pharmacokinetics, we suggest the following schedule based on the type of therapy: one month (glatiramer), two months (fingolimod) or three months (interferons, natalizumab) prior to anticipated conception. It is less clear when to resume the therapy following the delivery.

Because only a minuscule amount of medications is excreted in mother’s milk, some MS specialists advise patients to resume therapy – with the exception of fingolimod or natalizumab – as soon as possible, even in women who intend to breast-feed. In the event of an MS relapse during or after the pregnancy, treatment with high dose intravenous methylprednisolone is generally considered safe for both mother and baby.

Multiple Sclorosis Center, SNI

James Bowen, MD, Multiple Sclorosis Center, Swedish Neuroscience Institute

The Multiple Sclerosis Center continues to grow. We have added an additional MS nurse, Reiko Aramaki, RN. Reiko joined us from the Evergreen MS Center. She is certified by the International Order of MS Nurses and will expand our ability to respond to patient’s needs.

Outreach programs also continue. Dr. Bowen was recently interviewed by Kathi Goertzen from KOMO TV4 regarding CCSVI. This interview can be seen at http://www.komonews.com/home/video/106166123.html.

Also, Chaz Gilbert, a patient care coordinator won the Seattle Verizon Urban Challenge on 10/30/10, racing through 12 checkpoints in their city using only clues, their feet and public transit.

Exciting Advances in MS from ECTRIMS

There is exciting news from last week’s 26th Congress of the European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS) in Gothenburg, Sweden.

ALEMTUZUMAB. 5-year data from a Phase II extension study for alemtuzumab, an intravenously administered monoclonal antibody, showed that the drug:

  • reduced annualized rate of relapse to 0.14 compared with 0.28 for interferon
  • reduced the risk for sustained accumulation of disability in remitting relapsing multiple sclerosis by 87% compared to 62% with interferon.

This is a remarkable agent with excellent activity in MS. Adverse events included immune thrombocytopenic purpura, thyroiditis and anti-glomerular basement membrane disease.

TERIFLUNOMIDE. A Phase III trial of oral teriflunomide in remitting relapsing MS showed:

  • a 31% reduction in relapse rate and increased time to first relapse compared with placebo
  • reduced the risk of sustained disability progression by 29.8%.

Side effects were mild and included diarrhea, nausea, liver function abnormalities and hair loss.

Alemtuzumab and teriflunomide are currently in Phase III clinical trials at SNI.

SNI PRESENTATIONS:

  • Dr. Jim Bowen presented a poster about ongoing demyelination and neurodegeneration in a patient who had undergone autologous stem cell transplantation.
  • Drs. Jung Henson and Mayadev reviewed the beneficial effects of exercise on functional and quality of life outcomes from SNI’s MS wellness program

Swedish Smyelin Babes Shift Into High Gear

The Bike MS Ride in Mount Vernon is almost here (September 11-12) and the Swedish Smyelin Babes bike team is 98 members strong and still growing! The team started out with 4 riders in 2006, and since then has grown to be the largest bike team, beating out even corporate groups like Team BP, Microsoft, Columbia Athletic Club and Point B. We are also the only bike team representing any of the MS centers in the Seattle region. Last year we raised over $84,000 to support the National Multiple Sclerosis Society, and we hope to beat that amount this year. Join Swedish Smyelin Babes or donate to this worthy cause!
Lily Jung Henson, MD
Swedish MS Center and SNI General Neurology