scholarly journals Recomendações Sobre a Abordagem da Esclerose Múltipla na Gravidez, Parto e Pós-Parto: Posição de Consenso do Grupo de Estudos de Esclerose Múltipla e da Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal

2018 ◽  
Vol 31 (12) ◽  
pp. 785
Author(s):  
Sónia Batista ◽  
Ana Martins da Silva ◽  
Maria José Sá ◽  
Lívia Sousa ◽  
João De Sá ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Young Women ◽  
Postpartum Period ◽  
State Of The Art ◽  
Healthcare Providers ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Disease Modifying Therapies ◽  
Multiple Sclerosis Patients

Multiple sclerosis typically affects young women of reproductive age. Therefore, all healthcare providers involved in the follow-up of multiple sclerosis patients must be prepared to discuss pregnancy and breastfeeding issues, and provide the best possible counselling. However, there are still many doubts and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. Concerning the handling of disease modifying therapies during pregnancy and the postpartum period, uncertainties have been complicated by the increase in recent years of the number of available treatments. This article aims to present the state-of-the-art and provide guidance based on the best level of available evidence and expert opinion regarding the management of multiple sclerosis patients at different stages: pregnancy planning, pregnancy, partum, and the postpartum period.

Pregravid preparation, pregnancy and childbirth, especially the course of the postpartum period in patients with multiple sclerosis (literature review)

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 30-34
Author(s):  
Anastasia D. Kupina ◽  
Yuriy A. Petrov
Keyword(s):  
Multiple Sclerosis ◽  
Postpartum Period ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Disease Etiology ◽  
Pubmed Central ◽  
Pregnancy And Childbirth ◽  
Autoimmune Inflammation ◽  
New Ideas ◽  
Chronic Autoimmune Disease

Multiple sclerosis (MS) is a chronic autoimmune disease characterized by the formation of lesions in the white matter as a result of autoimmune inflammation, neurodegeneration and demyelination and leading to severe disability of patients. Women get sick more often than men; young women of reproductive age account for about 2/3 of all MS patients. It was established that pregnancy and childbirth with MS have a beneficial effect on the course of the disease, however, patients with MS need pregravid preparation, which will reduce the risk of exacerbations. Exacerbations are observed in most cases during the first 36 months of the postpartum period, which is associated with a change in hormonal status, emotional and physical stress on the womans body, and also with the cessation of physiological immunosuppression in a pregnant woman. The analysis of modern literature sources on the issues of pregravid preparation, pregnancy and childbirth, and the features of postpartum period in multiple sclerosis, as well as new ideas concerning the disease etiology and pathogenesis. 47 literature sources (national and foreign) were analyzed using various databases (PubMed, PubMed Central, Google Scholar, UpToDate).

scholarly journals Anti-adhesion Gel versus No gel following Operative Hysteroscopy prior to Subsequent fertility Treatment or timed InterCourse (AGNOHSTIC), a randomised controlled trial: protocol

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
S van Wessel ◽  
T Hamerlynck ◽  
V Schutyser ◽  
C Tomassetti ◽  
C Wyns ◽  
...  
Keyword(s):  
Live Birth ◽  
Financial Support ◽  
Controlled Trial ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Operative Hysteroscopy ◽  
Randomised Controlled

Abstract STUDY QUESTIONS Does the application of anti-adhesion gel, compared to no gel, following operative hysteroscopy to treat intrauterine pathology in women wishing to conceive increase the chance of conception leading to live birth? WHAT IS KNOWN ALREADY Intrauterine adhesions (IUAs) following operative hysteroscopy may impair reproductive success in women of reproductive age. Anti-adhesion barrier gels may decrease the occurrence of IUAs, but the evidence on their effectiveness to improve reproductive outcomes is sparse and of low quality. STUDY DESIGN, SIZE, DURATION This multicentre, parallel group, superiority, blinded and pragmatic randomised controlled trial is being carried out in seven participating centres in Belgium. Recruitment started in April 2019. Women will be randomly allocated to treatment with anti-adhesion gel (intervention group) or no gel (control group). Sterile ultrasound gel will be applied into the vagina as a mock-procedure in both treatment arms. The patient, fertility physician and gynaecologist performing the second-look hysteroscopy are unaware of the allocated treatment. Power analysis, based on a target improvement of 15% in conception leading to live birth using anti-adhesion gel, a power of 85%, a significance level of 5%, and a drop-out rate of 10%, yielded a number of 444 patients to be randomised. The baseline rate of conception leading to live birth in the control group is expected to be 45%. PARTICIPANTS/MATERIALS, SETTING, METHODS Women of reproductive age (18–47 years), wishing to conceive (spontaneously or by fertility treatment) and scheduled for operative hysteroscopy to treat intrauterine pathology (endometrial polyps, myomas with uterine cavity deformation, uterine septa, IUAs or retained products of conception) are eligible for recruitment. Women may try to conceive from 3 to 6 weeks after receiving allocated treatment with follow-up ending at 30 weeks after treatment. If the woman fails to conceive within this timeframe, a second-look hysteroscopy will be scheduled within 2–6 weeks to check for IUAs. The primary endpoint is conception leading to live birth, measured at 30 weeks after randomisation. The secondary endpoints are time to conception, clinical pregnancy, miscarriage and ectopic pregnancy rates, measured at 30 weeks after receiving allocated treatment. The long-term follow-up starts when the patient is pregnant and she will be contacted every trimester. STUDY FUNDING/COMPETING INTEREST(S) This work is funded by the Belgian Healthcare Knowledge Centre (KCE). The anti-adhesion gel is supplied at no cost by Nordic Pharma and without conditions. Dr. Tomassetti reports grants and non-financial support from Merck SA, non-financial support from Ferring SA, personal fees and non-financial support from Gedeon-Richter, outside the submitted work. None of the other authors have a conflict of interest.

scholarly journals Disability improvement as a clinically relevant outcome in clinical trials of relapsing forms of multiple sclerosis

2021 ◽  
pp. 135245852110002
Author(s):  
Bruce AC Cree ◽  
Jeffrey A Cohen ◽  
Anthony T Reder ◽  
Davorka Tomic ◽  
Diego Silva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Therapeutic Benefit ◽  
Disease Modifying Therapies ◽  
Long Term Follow Up ◽  
Post Hoc ◽  
Switch Group ◽  
Relevant Outcome

Background: Disease-modifying therapies (DMTs) can reduce the risk of disability worsening in patients with relapsing forms of multiple sclerosis (RMS). High-efficacy DMTs can lead to confirmed or sustained disability improvement (CDI and SDI). Objective and Methods: Post hoc analyses of data from the TRANSFORMS, FREEDOMS, and FREEDOMS II trials and their extensions assessed the effects of fingolimod (0.5–1.25 mg/day) on stabilizing or improving disability over ⩽8 years in participants with RMS. CDI and SDI rates were compared between participants initially randomized to fingolimod, interferon (IFNβ-1a), or placebo. Results: At 8 years’ follow-up in TRANSFORMS, 35.1% (95% confidence interval [CI], 28.2%–43.1%) of assessed participants in the IFNβ-1a–fingolimod switch group and 41.9% (36.6%–47.6%) on continuous fingolimod experienced CDI; disability did not worsen in approximately 70%. Similar results were seen in the combined FREEDOMS population. Proportionally fewer TRANSFORMS participants achieved SDI in the IFNβ-1a–fingolimod switch group than on continuous fingolimod (5.4% [3.0%–9.5%] vs 14.2% [10.8%–18.4%], p = 0.01). Conclusion: CDI and SDI are outcomes of interest for clinical trials and for long-term follow-up of participants with RMS. Monitoring CDI and SDI in addition to disability worsening may facilitate understanding of the therapeutic benefit of RMS treatments.

scholarly journals PREVALENCE AND CORRELATES OF BACTERIAL VAGINOSIS AMONG YOUNG WOMEN OF REPRODUCTIVE AGE IN MYSORE, INDIA

2008 ◽  
Vol 26 (2) ◽  
pp. 132-137
Author(s):  
P Madhivanan ◽  
K Krupp ◽  
V Chandrasekaran ◽  
C Karat ◽  
A Arun ◽  
...  
Keyword(s):  
Bacterial Vaginosis ◽  
Young Women ◽  
Reproductive Age ◽  
Women Of Reproductive Age

scholarly journals Multiple Sclerosis Treated with Antithymocyte Globulin — A Five Year Follow-Up

1978 ◽  
Vol 5 (2) ◽  
pp. 175-178 ◽  
Author(s):  
L.F. Kastrukoff ◽  
D.R. McLean ◽  
T.A. McPherson
Keyword(s):  
Multiple Sclerosis ◽  
Total Protein ◽  
Antithymocyte Globulin ◽  
Gamma Globulin ◽  
Multiple Sclerosis Patients ◽  
Term Benefit

SUMMARY:Multiple sclerosis patients treated with antithymocyte globulin (ATG) were re-evaluated after five years. No long term benefit was found. Notably, the group of patients with an elevated gamma globulin to total protein ration in their C.S.F. and who did particularly well after treatment with ATG also failed to show any long term benefit. Few long term detrimental effects of ATG immunosuppression were identified. The implications of the results are discussed as they relate to the use of immunosuppression in multiple sclerosis.

Multimodal evoked potentials follow up in multiple sclerosis patients under fingolimod therapy

2016 ◽  
Vol 365 ◽  
pp. 143-146 ◽  
Author(s):  
R. Iodice ◽  
A. Carotenuto ◽  
R. Dubbioso ◽  
I. Cerillo ◽  
L. Santoro ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Multimodal Evoked Potentials ◽  
Multiple Sclerosis Patients

scholarly journals Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

2021 ◽  
Author(s):  
Ilkka Rauma ◽  
Tiina Mustonen ◽  
Juha Matti Seppä ◽  
Maritta Ukkonen ◽  
Marianne Männikkö ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Case Series ◽  
Retrospective Case ◽  
Serious Adverse Events ◽  
Highly Active ◽  
Disease Modifying Therapy ◽  
Case Series Study ◽  
Multiple Sclerosis Patients

Abstract Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1–3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.

Pregnancy in patients with multiple sclerosis

2021 ◽  
pp. jim-2020-001609
Author(s):  
Borros M Arneth
Keyword(s):  
Multiple Sclerosis ◽  
Autoimmune Disorder ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Research Results ◽  
Search Terms ◽  
Fetal Complications ◽  
Relapse Rates

Multiple sclerosis (MS) is an autoimmune disorder that affects ~2.5 million people globally. Women of reproductive age are highly susceptible to this disease. This study aims to explore the association between MS and pregnancy. Articles related to the topic under investigation were identified; the search terms included “pregnancy”, “multiple sclerosis”, “MS”, and “women”. Only articles published between 2010 and 2020 were included in the review. This review shows that researchers have attempted to explore the link between pregnancy and MS, and the results from previous studies indicate that pregnancy reduces the risk of MS relapse. However, evidence suggesting that pregnancy can affect the long-term progression of MS is lacking. The research results also indicate that MS does not increase the risk of maternal and fetal complications. MS remains a serious autoimmune disorder that affects many women worldwide. The data gathered during this review indicate that a significant correlation exists between pregnancy and MS relapse rates. The findings presented in this review can aid in the management of MS during pregnancy. Furthermore, these research results provide vital insights that caregivers can use to monitor patients with MS during pregnancy.

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