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.