Thursday, 9 February 2017

#ResearchSpeal: oral contraceptives in the real world

How does the pill reduce your chances of having a relapse? #ResearchSpeak #MSBlog

There are clearly many sex-related differences in MS. Some of these differences may be due to hormonal factors. Women have a higher incidence and prevalence of MS and there is evidence that oestrogens may have a positive effect on disease course as does pregnancy. Recent studies also suggest early menopause, which causes a drop in circulating oestrogen may be associated with a poorer outcome. The question therefore arises of how does oestrogen-supplementation, for example with the oral contraceptive pill (OCP), affect the outcome in MS? 



The study below shows that prior OCP users had significantly lower relapse rates than never-users. This should be reassuring for women with MS. This study clearly needs to be replicated and supports finding out what mechanisms of action underlie this observation. The latter can then be manipulated to develop a new, possibly safer, class of DMTs. For example, new classes of drugs that target different oestrogen receptors. 

Bove et al. Oral contraceptives and MS disease activity in a contemporary real-world cohort. Mult Scler. 2017 Feb 1:1352458517692420.


BACKGROUND: There is uncertainty regarding the effect of oral hormonal contraceptives (OC) on multiple sclerosis (MS) course.

OBJECTIVE: To evaluate the hypothesis that OC use is associated with decreased risk of relapses in an observational study of women of childbearing age with new-onset MS starting a first-line injectable disease-modifying therapy (DMT).

METHODS: From our CLIMB longitudinal observational study, we identified 162 women with MS or CIS with known OC use who initiated injectable DMT within two years of symptom onset, and categorized OC use at DMT onset as past, ever or never. Our primary analysis was comparison of annualized relapse rate from baseline DMT start across the three OC use categories using a negative binomial regression model.

RESULTS: In this cohort of 162 women, 81 were treated with interferon therapy and 81 with glatiramer acetate. Mean ages for current-, past-, and never-OC users were 31.4 ( n = 46), 40.3 ( n = 66), and 37.9 ( n = 50) years, respectively ( p < 0.05); mean disease duration (1.0 years) and median baseline EDSS (1.0) did not differ between groups. Prior OC users had significantly lower relapse rates than never-users ( p = 0.031); the lower annualized relapse rate in current-users relative to never-users was not significant ( p = 0.91). Annualized relapse rate was not significantly different across the OC groups ( p = 0.057, three-group comparison).

CONCLUSIONS: These observations provide reassurance for women newly diagnosed that OC use, past or current, does not appear to be associated with greater risk of relapses.

4 comments:

  1. Around 10 years before I got MS I was on microgynon pill for a few years and became depressed. My mood improved after coming off this pill. I tried another pill some time later celest, which was slightly better but was glad to come off it. I would not want to go on the pill again.

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  2. And studies that say otherwise, that using oral contraceptives may increase the risk of developing MS in women? This study presented in AAN 2014 showed a 35% increase in MS in women who used for up to 4 years oral contraceptives. Would the oral contraceptive create a dependence on the body's dose response to estrogen?

    http://www.medscape.com/viewarticle/821579

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  3. I wish I knew whether to take the pill or not! As Cinera says, there are so many conflicting studies!

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  4. As a woman who has had three babies, is done having children and doesn't have to worry about contraception (husband had a vasectomy), should going on the BCP be something I should consider to help my MS? I have a worsening of my MS symptoms in the week before my period.

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