Abstract Details

Title Pregnancy Outcomes and Disease Course in NMOSD and MOGAD in CANOPTICS

Topic Multiple Sclerosis

Presentation(s) N2 - Neuroscience in the Clinic: What Should a Neurologist Know About Pregnancy and Lactation? (4:15 PM-4:25 PM)

Poster/Presentation
Number 002

Background

There is evidence that the risk for adverse pregnancy outcomes is higher in NMOSD/MOGAD, and disease activity may increase during pregnancy and postpartum.

Objective

To assess pregnancy and disease outcomes in patients with aquaporin-4-positive (AQP+) NMOSD, seronegative (AQP4-/MOG-) NMOSD, and MOGAD.

Design/Methods

CANOPTICS is a multicentre prospective Canadian cohort study of persons with NMOSD and MOGAD. Standardized forms are utilized to collect information on patients through the disease course, including information on pregnancy. Females of reproductive age (15-50 years) were included in this analysis. We retrospectively evaluated pregnancies in NMOSD/MOGAD for pregnancy outcomes and disease activity.

Results

Among 99 individuals of reproductive age, there were 26 pregnancies in 23 participants (14 AQP4+, 4 AQP-/MOG-, 8 MOGAD pregnancies). Pregnant and non-pregnant groups had similar age of symptom onset and EDSS at enrolment. Immunotherapy with prednisone and/or azathioprine was used during pregnancy in 4/14 AQP4+ and 1/8 MOGAD pregnancies. Live birth occurred in 11 (79%) AQP4+, 2 (50%) AQP4-/MOG-, and 8 (100%) MOGAD pregnancies. Miscarriages/stillbirth occurred in 2 (14%) AQP4+ and 2 (50%) AQP4-/MOG- pregnancies. One AQP4+ participant had a pregnancy termination. There were no preterm births, congenital malformations, or pre-eclampsia/eclampsia. There was one relapse during pregnancy, in the second trimester in a seronegative participant who was not on immunotherapy. The proportion with postpartum relapse was high, affecting 10 (71%) AQP4+, 1 (25%) seronegative, and 7 (88%) MOGAD pregnancies. Most relapses occurred in the first 3 months postpartum.

Conclusions

In this multicentre study of women with NMOSD and MOGAD, pregnancy outcomes were generally favourable, and most pregnancies resulted in live birth. Unlike prior studies, most did not have relapses during pregnancy. Conversely, the rate of postpartum relapse was high in both NMOSD and MOGAD, with most attacks occurring within the first 3 months postpartum. Factors influencing pregnancy and disease outcomes warrant further investigation.

Authors/Disclosures
Laura Chu, MD (BARLO MS Centre) PRESENTER	Dr. Chu has nothing to disclose.
Dalia Rotstein, MD	Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen/Horizon . Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion . Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Aventis. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion . Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen . Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. The institution of Dr. Rotstein has received research support from MS Canada. The institution of Dr. Rotstein has received research support from CMSC. The institution of Dr. Rotstein has received research support from Roche Canada. Dr. Rotstein has received research support from National MS Society.
Mark S. Freedman, MD, FAAN (University of Ottawa)	Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Actelion(Janssen/J&J). Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BiogenIdec. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS/Celgene. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Inc. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Actelion (Janssen/J&J). Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Atara Biotherapeutics. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer Healthcare. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BiogenIdec. Dr. Freedman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Clene Nanomedicine. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GRI Bio. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Magenta Therapeutics. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Dr. Freedman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Freedman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Freedman has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Freedman has received research support from Sanofi Genzyme.
Andrea Konig (St. Michael's Hospital)	No disclosure on file
Liesly Lee, MD (Sunnybrook Health Sciences Centre)	Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Aventis. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis.
Ruth-Ann Marrie, MD (University of Manitoba)	The institution of Dr. Marrie has received research support from CIHR. The institution of Dr. Marrie has received research support from MS Canada. The institution of Dr. Marrie has received research support from National MS Society. The institution of Dr. Marrie has received research support from Crohn's and Colitis Canada. The institution of Dr. Marrie has received research support from US Department of Defense. The institution of Dr. Marrie has received research support from The Arthritis Society. The institution of Dr. Marrie has received research support from CMSC.
Jennifer McCombe, MD (University of Alberta)	Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon therapeutics. Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Horizon therapeutics. Dr. McCombe has received personal compensation in the range of $500-$4,999 for serving as a traveling fellow with Royal College of Canada.
Sarah A. Morrow, MD, MSC, FRCPC, FAAN	Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BIogen Idec. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono/Merck. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SanofiGenzyme. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen Idec. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMDSerono/Merck. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. Dr. Morrow has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for sanofi genzyme. Dr. Morrow has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS/Celgene. The institution of Dr. Morrow has received research support from EMD Serono. The institution of Dr. Morrow has received research support from Novartis. The institution of Dr. Morrow has received research support from Roche. The institution of Dr. Morrow has received research support from Celgene.
Natalie E. Parks, MD (Dalhousie University)	Dr. Parks has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Parks has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis.
Penelope S. Smyth, MD (University of Alberta)	Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis Pharmaceuticals. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Canada. Dr. Smyth has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Short Term Exceptional Drug Therapy Program Alberta. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen-Idec. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion Pharmaceuticals. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Dr. Smyth has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis Pharmaceuticals.
Kristen M. Krysko, MD (St. Michael's Hospital)	Dr. Krysko has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Krysko has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Krysko has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Krysko has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Krysko has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Krysko has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. Krysko has received research support from MS Society of Canda. The institution of Dr. Krysko has received research support from Roche.