FP19-1 LONG-TERM IMPACT OF COMBINED ORAL CONTRACEPTIVE USE ON DISABILITY PROGRESSION IN RELAPSING-REMITTING MULTIPLE SCLEROSIS

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP19-Female Reproductive Endocrinology
Basic/Clinical
Sunday, June 16, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:45 AM
Room 102 (Moscone Center)

Poster Board SUN-498
Giulia Gava1, Fabrizio Salvi2, Ilaria Bartolomei2, Marta Berra1, Ilaria Mancini1, Martina Lambertini1, Stefano Venturoli1 and Cristina Maria Meriggiola*1
1University of Bologna, Bologna, Italy, 2Department of Neurological Science, Bellaria Hospital, Bologna, Italy
Background. Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Gender-related differences in brain damage, clinical evolution and several in vitro studies indicate a potential role of sex steroid hormones in the modulation of disease activity. Oral contraceptives (OC) are a source of exogenous sex hormones widely used by women during their reproductive years. Whether their use is safe in women with MS and their possible beneficial effects on disability progression is still unclear.

Aim. A retrospective cross-sectional study designed to assess the long-term effects of combined OC (COC) on the clinical course of relapsing-remitting onset MS (RR-MS), especially on disability progression and evolution in secondary progressive MS (SP-MS).

Design & Methods. 174 women with clinically and MRI-confirmed RR-MS lasting more than one year were recruited. The following data were collected: clinical neurological data, age at onset of MS, disease duration, annualized relapse rate, disease-modifying therapies (DMT), evaluation of disability with Expanded Disability Status Scale (EDSS) and evolution in SP-MS, gynecological and obstetric history including age, duration and type of OC intake.

Results. Length of follow up of MS was 14 ± 10 years. COC-users (n=111) had lower EDSS scores (p=0.004) and reduced tendency to evolve to SP-MS (p=0.008) compared to non-users (n=63). After correction for confounding variables, such as duration of disease, DMT, age of menarche and parity, the use of COC remained associated with lower EDSS scores (p=0.011 with eta-squared 0.038). Using multivariate survival analysis with Cox's regression model, non-use of COC was a predictor of evolution in SP-MS (p=0.001 and OR=3.499 95% CI=1.673–7.321). Use of COC after the onset of MS (n=78) was associated with significantly lower EDSS scores (p=0.005) and with a reduced tendency of progression to SP-MS (p=0.001). The annualized relapse rate was not influenced by COC use. No differences in EDSS scores and evolution to SP-MS depending upon COC formulation were detected.

Conclusions. Our results suggest that COC use in RR-MS women is associated with a less severe disease and less severe evolution. Whether different doses or types of progestin may have different effects remain to be defined.

Nothing to Disclose: GG, FS, IB, MB, IM, ML, SV, CMM

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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