News in brief: Relapse rates around pregnancy in MS have improved; Women under represented in stroke trials; Parkinson medication link to colitis

29 Apr 2021

MS relapse rates around pregnancy have improved

High efficacy DMT continuation to, or beyond, conception in women with MS has markedly reduced relapse rates over the last ten years compared to historical cohorts.

An Australian-led study of MS relapse in 1,619 women before, during and after pregnancy found the annualised relapse rate was 0.288 for pregnancies from 2011 onwards compared to 0.468 for pregnancies between 2005 and 2010, and 0.555 for pre-2005 pregnancies.

Natalizumab continuation into pregnancy was protective against intrapartum relapse (OR 0.755; p=0.017). Post-delivery DMT initiation, particularly with natalizumab, was also protective against early postpartum relapse (HR 0.111; p<0.0001).

“Continuation of natalizumab, at 6-to-8- weekly intervals, up to the 32nd-34th week of pregnancy is an option to prevent relapse in those deemed at elevated relapse risk whilst minimising fetal exposure,” the study said.

Women who breastfed were also less likely to relapse (HR 0.61, p=0.016).

“Given breastfeeding has maternal and newborn benefits, it should be encouraged,” it said.


Do better with gender equity in stroke trials 

Women are under enrolled in RCTs of acute stroke therapies, a meta-analysis of the evidence has found.

The analysis of 115 trials found 43.5% of the 121,105 participants were women. Overall, women were under enrolled by an absolute difference of 5.3 percentage points relative to their representation in the underlying stroke populations.

The JAMA Neurology study found the disparity was evident in virtually all geographic regions, intervention types and stroke types apart from subarachnoid haemorrhage.

It found upper age limits placed on trial enrollment exclude more women.

“The imposition of an upper age limit of 80 years or younger was associated with a 6–percentage point decrease in the enrollment of women, while requirements for IVT eligibility and EVT eligibility were associated with 3–percentage point increases in the enrollment of women after adjustment,” the study said.

An editorial said the study’s findings were consistent with evidence of underrepresentation of women in lipid-lowering, heart failure, arrhythmia and hypertension trials.

It said researchers have a public health obligation to ensure adequate recruitment of women into cardiovascular trials.

 Parkinson medication may cause colitis

Microscopic colitis is more common than previously suspected in patients with Parkinson disease taking levodopa/dopa decarboxylase therapy, according to neurologists in NSW.

Clinicians at the Movement Disorders Clinic at Sydney’s Westmead Hospital have reported 22 cases of PD patients who developed microscopic colitis during treatment with therapies such as oral levodopa/benserazide. They found the colitis had variable time of onset and did not always respond to a change in therapy or restarting therapy.

While they could not provide a mechanism of action for the adverse reaction, they said colitis should be suspected in any PD patient with unexplained acute, subacute, or chronic, non-bloody or watery diarrhoea, and other aetiologies excluded.

“If diarrhoea persists, colonoscopy and random colonic biopsy should be performed even if the endoscopic appearance is normal,” they suggested.

“A carefully supervised trial of withdrawal may be required as a last resort,” they added

More details: Parkinsonism and Related Disorders.


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