Author Of 1 Presentation
P0072 - Effect of switching disease modifying drugs on relapse rate in stable relapsing remitting multiple sclerosis patients planning for pregnancy. (ID 580)
Abstract
Background
The decision to have children is complex for multiple sclerosis patients due to the range of aspects that affect it. One of the most important aspects is the use of disease modifying drugs (DMDs) when planning or during pregnancy and how continuing, stopping or switching them may affect the disease course. It is always better to avoid the use of medications during pregnancy but in patients with severe disease stopping their medium or high potency medications imposes high risk of disease recurrence, rebound or Immune Reconstitution Inflammatory Syndrome (IRIS),specifically when stopping Natalizumab (NTZ) or Fingolimod. Switching to another medication that can be used up to conception and even during pregnancy which are either Glatiramer acetate (GA) or Interferons (IFNs) may be an option.
Objectives
To review available evidence on the effect of different switching strategies in stable relapsing remitting MS (RRMS) patients on clinical and radiological disease activity.
Methods
We searched MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane Library up to March 2020. No limits or restrictions on time or study design were applied, but only papers written in English were included. We used the revised Cochrane risk of bias tool for randomized trials (ROB2), and national heart, lung and blood institute (NIH) quality assessment tool for before-after (pre-post) with no control group cohort studies.
Results
Seven articles that matched the inclusion criteria were included: 4 cohorts, 2 case reports and one RCT. Results were synthesized narratively and Meta-analysis was not possible due to high heterogeneity (limited treatment overlap) between the studies. Four different switching strategies were identified, the first three were considered de-escalation from high to low potency DMDs, (NTZ to GA), (NTZ to monthly methylprednisolone for three months then GA) which is called (bridging) and (NTZ to IFN). All studies measured the mean change in annualized relapse rate after switching as disease activity measure. These switches showed some protection from rebound and IRIS but not from disease recurrence. The fourth strategy IFN to GA (switching between first line injectables), showed disease stability in two case reports.
Conclusions
Evidence on switching strategy effect on disease course in stable RRMS patients is scarce, available data suggests partial activity in case of de-escalation, and stability in case of switching between first line injectables.