COPP-MS: COrticosteroids during the Post-Partum in relapsing Multiple Sclerosis patients

Soizic Leguy (1, 2) , Mathilde Lefort (3, 4) , Lucile Lescot (1, 2) , Audrey Michaud (3, 4) , Sandra Vukusic (5, 6, 7) , Emmanuelle Le Page (1, 2) , Gilles Edan (1, 2) , Anne Kerbrat (1, 2) , Christine Lebrun-Frenay (8) , Jérôme de Sèze (8, 9) , David-Axel Laplaud (10) , Sandrine Wiertlewski (10) , Emmanuelle Leray (3, 4, 11, 12, 13) , Laure Michel (1, 2, 14)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 CIC - Centre d'Investigation Clinique [Rennes]
3 ARENES - Arènes: politique, santé publique, environnement, médias
4 RSMS - Recherche sur les services et le management en santé
5 HCL - Hospices Civils de Lyon
6 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
7 Fondation Eugène Devic EDMUS
8 CHU Nice - Centre Hospitalier Universitaire de Nice
9 Centre d’Investigation Clinique Plurithématique (CIC - P) - CIC Strasbourg
10 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
11 EHESP - École des Hautes Études en Santé Publique [EHESP]
12 METIS - Département Méthodes quantitatives en santé publique
13 CoRHASI - Collectif de recherche handicap, autonomie et société inclusive
14 MOBIDIC - Microenvironment and B-cells: Immunopathology,Cell Differentiation, and Cancer

Background: No specific treatment has demonstrated its effectiveness to prevent post-partum relapses for multiple sclerosis (MS) women.Objective: To assess the effectiveness of preventive high-dose corticosteroids in the post-partum period by comparing two strategies: (1) no preventive treatment and (2) standardized preventive treatment.Methods: We selected five French Multiple Sclerosis centers using the same post-partum strategy for their patients-either high-dose steroids (treating centers TC) or no treatment (non-treating centers NTC). We included relapsing-remitting multiple sclerosis women who delivered between January 2007 and January 2017. Our primary outcomes were the time from delivery to first relapse, EDSS progression and MRI activity between patients of treating centers and non-treating centers, after propensity-score weighting.Results: 350 patients were included (116 from treating centers, 234 from non-treating centers). For both groups, the annualized relapse rate decreased during pregnancy (0.28 in treating centers and 0.34 in non-treating centers during the third trimester) and increased during the first post-partum trimester (0.45 and 0.69, respectively) with 11% and 14% (NS) of patients facing at least one relapse, respectively. Our primary outcomes were not statistically different between both groups.Conclusion: This study provides class III evidence that systematic high-dose corticosteroids are not associated with a reduced inflammatory activity during the post-partum period in multiple sclerosis patients.

Mots clés: Disability; Multiple sclerosis; Post-partum; Preventive corticosteroids; Relapses

Domaines: Santé publique et épidémiologie

Soizic Leguy, Mathilde Lefort, Lucile Lescot, Audrey Michaud, Sandra Vukusic, et al.. COPP-MS: COrticosteroids during the Post-Partum in relapsing Multiple Sclerosis patients. Journal of Neurology, 2022, 269 (269), pp.5571-5581. ⟨10.1007/s00415-022-11215-7⟩. ⟨hal-03704177⟩