Increased risk of multiple sclerosis relapse after in vitro fertilisation
Identifieur interne : 001D29 ( Main/Exploration ); précédent : 001D28; suivant : 001D30Increased risk of multiple sclerosis relapse after in vitro fertilisation
Auteurs : Laure Michel [France] ; Yohann Foucher [France] ; Sandra Vukusic [France] ; Christian Confavreux [France] ; Jérome De Sèze [France] ; David Brassat [France] ; Michel Clanet [France] ; Pierre Clavelou [France] ; Jean-Christophe Ouallet [France] ; Bruno Brochet [France] ; Jean Pelletier [France] ; Pierre Labauge [France] ; Christine Lebrun [France] ; Emmanuelle Lepage [France] ; Fabienne Le Frere [France] ; Marylène Jacq-Foucher [France] ; Paul Barriere [France] ; Sandrine Wiertlewski [France] ; David-Axel Laplaud [France]Source :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2012-08.
English descriptors
- Teeft :
- Agonist, Antagonist, Cedex, Centre, Centre hospitalier universitaire, Cohort, Control period, Database, Disease duration, Fertilisation, Frailty, Frailty model, French university hospitals, General strategy, Gnrh, Gnrh agonists, Gnrh antagonists, Last relapse, Median, Median range, Medical information, Medical records, Month period, Multiple sclerosis, Multiple sclerosis group, Multivariate, Multivariate analyses, Multivariate frailty model, Multivariate poisson regression analysis, Nantes, Nantes cedex, Neurol, Neurol neurosurg psychiatry, Neurologie, Neurologist, Neurosurg, Ovarian, Ovarian desensitisation, Ovarian stimulation, Pregnancy, Relapse, Relapse rate, Same results, Sclerosis, Statistical analyses, Stressful life events, Supplementary table, Toulouse, Wilcoxon, Wilcoxon test.
Abstract
Background Exogenous sexual steroids together with pregnancy have been shown to influence the risk of relapses in multiple sclerosis (MS). Treatments used during assisted reproductive techniques may consequently influence the short term evolution of MS by modifying the hormonal status of the patient. The objective of this study was to determine if there was an increased risk of developing exacerbations in women with MS after in vitro fertilisation (IVF). Methods MS and IVF data were either automatically extracted from 13 French university hospital databases or obtained from referring neurologists. After matching databases, patient clinical files were systematically reviewed to collect information about MS and the treatments used for IVF. The association between IVF and the occurrence of MS relapses was analysed in detail using univariate and multivariate statistical tests. Findings During the 11 year study period, 32 women with MS had undergone 70 IVF treatments, 48 using gonadotrophin releasing hormone (GnRH) agonists and 19 using GnRH antagonists. A significant increase in the annualised relapse rate (ARR) was observed during the 3 month period following IVF (mean ARR 1.60, median ARR 0) compared with the same period just before IVF (mean ARR 0.80, median ARR 0) and to a control period 1 year before IVF (mean ARR 0.68, median ARR 0). The significant increase in relapses was associated with the use of GnRH agonists (Wilcoxon paired test, p=0.025) as well as IVF failure (Wilcoxon paired test, p=0.019). Interpretation An increased relapse rate was observed in this study after IVF in patients with MS and may be partly related both to IVF failure and the use of GnRH agonists.
Url:
DOI: 10.1136/jnnp-2012-302235
Affiliations:
- France
- Alsace (région administrative), Auvergne (région administrative), Auvergne-Rhône-Alpes, Grand Est, Pays de la Loire, Rhône-Alpes, Région Bretagne
- Clermont-Ferrand, Lyon, Nantes, Rennes, Strasbourg
- Université de Nantes
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region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="De Seze, Jerome" sort="De Seze, Jerome" uniqKey="De Seze J" first="Jérome" last="De Sèze">Jérome De Sèze</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, University Hospital of Strasbourg, Strasbourg</wicri:regionArea><placeName><region type="region">Grand Est</region><region type="old region">Alsace (région administrative)</region><settlement type="city">Strasbourg</settlement></placeName></affiliation></author><author><name sortKey="Brassat, David" sort="Brassat, David" uniqKey="Brassat D" first="David" last="Brassat">David Brassat</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, CHU de Toulouse</wicri:regionArea><wicri:noRegion>CHU de Toulouse</wicri:noRegion><wicri:noRegion>CHU de 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Christophe" sort="Ouallet, Jean Christophe" uniqKey="Ouallet J" first="Jean-Christophe" last="Ouallet">Jean-Christophe Ouallet</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>CHU Pellegrin, groupe hospitalier Pellegrin-Tripode, Bordeaux cedex</wicri:regionArea><wicri:noRegion>Bordeaux cedex</wicri:noRegion><wicri:noRegion>Bordeaux cedex</wicri:noRegion></affiliation></author><author><name sortKey="Brochet, Bruno" sort="Brochet, Bruno" uniqKey="Brochet B" first="Bruno" last="Brochet">Bruno Brochet</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>CHU Pellegrin, groupe hospitalier Pellegrin-Tripode, Bordeaux cedex</wicri:regionArea><wicri:noRegion>Bordeaux cedex</wicri:noRegion><wicri:noRegion>Bordeaux cedex</wicri:noRegion></affiliation></author><author><name sortKey="Pelletier, Jean" sort="Pelletier, Jean" uniqKey="Pelletier J" first="Jean" last="Pelletier">Jean Pelletier</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, CHU Timone, Marseille cedex</wicri:regionArea><wicri:noRegion>Marseille cedex</wicri:noRegion><wicri:noRegion>Marseille cedex</wicri:noRegion></affiliation></author><author><name sortKey="Labauge, Pierre" sort="Labauge, Pierre" uniqKey="Labauge P" first="Pierre" last="Labauge">Pierre Labauge</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Nîmes CEDEX</wicri:regionArea><wicri:noRegion>Nîmes CEDEX</wicri:noRegion><wicri:noRegion>Nîmes CEDEX</wicri:noRegion></affiliation></author><author><name sortKey="Lebrun, Christine" sort="Lebrun, Christine" uniqKey="Lebrun C" first="Christine" last="Lebrun">Christine Lebrun</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, CHU de Nice, Nice cedex</wicri:regionArea><wicri:noRegion>Nice cedex</wicri:noRegion><wicri:noRegion>Nice cedex</wicri:noRegion></affiliation></author><author><name sortKey="Lepage, Emmanuelle" sort="Lepage, Emmanuelle" uniqKey="Lepage E" first="Emmanuelle" last="Lepage">Emmanuelle Lepage</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, Hôpital Pontchaillou, Rennes</wicri:regionArea><placeName><region type="region">Région Bretagne</region><region type="old region">Région Bretagne</region><settlement type="city">Rennes</settlement></placeName></affiliation></author><author><name sortKey="Le Frere, Fabienne" sort="Le Frere, Fabienne" uniqKey="Le Frere F" first="Fabienne" last="Le Frere">Fabienne Le Frere</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>CIC Inserm 004, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation></author><author><name sortKey="Jacq Foucher, Marylene" sort="Jacq Foucher, Marylene" uniqKey="Jacq Foucher M" first="Marylène" last="Jacq-Foucher">Marylène Jacq-Foucher</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>CIC Inserm 004, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation></author><author><name sortKey="Barriere, Paul" sort="Barriere, Paul" uniqKey="Barriere P" first="Paul" last="Barriere">Paul Barriere</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Biologie de la reproduction, Centre Hospitalier Universitaire de Nantes, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation></author><author><name sortKey="Wiertlewski, Sandrine" sort="Wiertlewski, Sandrine" uniqKey="Wiertlewski S" first="Sandrine" last="Wiertlewski">Sandrine Wiertlewski</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>CIC Inserm 004, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation></author><author><name sortKey="Laplaud, David Axel" sort="Laplaud, David Axel" uniqKey="Laplaud D" first="David-Axel" last="Laplaud">David-Axel Laplaud</name><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>Service de Neurologie, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Institut de Transplantation Et de Recherche en Transplantation, Inserm UMR643, Nantes</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Nantes</settlement></placeName></affiliation><affiliation wicri:level="1"><country xml:lang="fr">France</country><wicri:regionArea>CIC Inserm 004, Centre Hospitalier Universitaire de Nantes, Hôpital Laennec, Nantes Cedex</wicri:regionArea><wicri:noRegion>Nantes Cedex</wicri:noRegion><wicri:noRegion>Nantes Cedex</wicri:noRegion></affiliation><affiliation wicri:level="3"><country wicri:rule="url">France</country><wicri:regionArea>Correspondence to Dr D-A Laplaud, INSERM U643, 30 Bd J Monnet, Nantes Cedex 44093</wicri:regionArea><placeName><region type="region" nuts="2">Pays de la Loire</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2012-08">2012-08</date><biblScope unit="volume">83</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="796">796</biblScope></imprint><idno type="ISSN">0022-3050</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Agonist</term><term>Antagonist</term><term>Cedex</term><term>Centre</term><term>Centre hospitalier universitaire</term><term>Cohort</term><term>Control period</term><term>Database</term><term>Disease duration</term><term>Fertilisation</term><term>Frailty</term><term>Frailty model</term><term>French university hospitals</term><term>General strategy</term><term>Gnrh</term><term>Gnrh agonists</term><term>Gnrh antagonists</term><term>Last relapse</term><term>Median</term><term>Median range</term><term>Medical information</term><term>Medical records</term><term>Month period</term><term>Multiple sclerosis</term><term>Multiple sclerosis group</term><term>Multivariate</term><term>Multivariate analyses</term><term>Multivariate frailty model</term><term>Multivariate poisson regression analysis</term><term>Nantes</term><term>Nantes cedex</term><term>Neurol</term><term>Neurol neurosurg psychiatry</term><term>Neurologie</term><term>Neurologist</term><term>Neurosurg</term><term>Ovarian</term><term>Ovarian desensitisation</term><term>Ovarian stimulation</term><term>Pregnancy</term><term>Relapse</term><term>Relapse rate</term><term>Same results</term><term>Sclerosis</term><term>Statistical analyses</term><term>Stressful life events</term><term>Supplementary table</term><term>Toulouse</term><term>Wilcoxon</term><term>Wilcoxon test</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Exogenous sexual steroids together with pregnancy have been shown to influence the risk of relapses in multiple sclerosis (MS). Treatments used during assisted reproductive techniques may consequently influence the short term evolution of MS by modifying the hormonal status of the patient. The objective of this study was to determine if there was an increased risk of developing exacerbations in women with MS after in vitro fertilisation (IVF). Methods MS and IVF data were either automatically extracted from 13 French university hospital databases or obtained from referring neurologists. After matching databases, patient clinical files were systematically reviewed to collect information about MS and the treatments used for IVF. The association between IVF and the occurrence of MS relapses was analysed in detail using univariate and multivariate statistical tests. Findings During the 11 year study period, 32 women with MS had undergone 70 IVF treatments, 48 using gonadotrophin releasing hormone (GnRH) agonists and 19 using GnRH antagonists. A significant increase in the annualised relapse rate (ARR) was observed during the 3 month period following IVF (mean ARR 1.60, median ARR 0) compared with the same period just before IVF (mean ARR 0.80, median ARR 0) and to a control period 1 year before IVF (mean ARR 0.68, median ARR 0). The significant increase in relapses was associated with the use of GnRH agonists (Wilcoxon paired test, p=0.025) as well as IVF failure (Wilcoxon paired test, p=0.019). Interpretation An increased relapse rate was observed in this study after IVF in patients with MS and may be partly related both to IVF failure and the use of GnRH agonists.</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Alsace (région administrative)</li><li>Auvergne (région administrative)</li><li>Auvergne-Rhône-Alpes</li><li>Grand Est</li><li>Pays de la Loire</li><li>Rhône-Alpes</li><li>Région Bretagne</li></region><settlement><li>Clermont-Ferrand</li><li>Lyon</li><li>Nantes</li><li>Rennes</li><li>Strasbourg</li></settlement><orgName><li>Université de Nantes</li></orgName></list><tree><country name="France"><noRegion><name sortKey="Michel, Laure" sort="Michel, Laure" uniqKey="Michel L" first="Laure" last="Michel">Laure Michel</name></noRegion><name sortKey="Barriere, Paul" sort="Barriere, Paul" uniqKey="Barriere P" first="Paul" last="Barriere">Paul Barriere</name><name sortKey="Brassat, David" sort="Brassat, David" uniqKey="Brassat D" first="David" last="Brassat">David Brassat</name><name sortKey="Brochet, Bruno" sort="Brochet, Bruno" uniqKey="Brochet B" first="Bruno" last="Brochet">Bruno Brochet</name><name sortKey="Clanet, Michel" sort="Clanet, Michel" uniqKey="Clanet M" first="Michel" last="Clanet">Michel Clanet</name><name sortKey="Clavelou, Pierre" sort="Clavelou, Pierre" uniqKey="Clavelou P" first="Pierre" last="Clavelou">Pierre Clavelou</name><name sortKey="Confavreux, Christian" sort="Confavreux, Christian" uniqKey="Confavreux C" first="Christian" last="Confavreux">Christian Confavreux</name><name sortKey="De Seze, Jerome" sort="De Seze, Jerome" uniqKey="De Seze J" first="Jérome" last="De Sèze">Jérome De Sèze</name><name sortKey="Foucher, Yohann" sort="Foucher, Yohann" uniqKey="Foucher Y" first="Yohann" last="Foucher">Yohann Foucher</name><name sortKey="Foucher, Yohann" sort="Foucher, Yohann" uniqKey="Foucher Y" first="Yohann" last="Foucher">Yohann Foucher</name><name sortKey="Jacq Foucher, Marylene" sort="Jacq Foucher, Marylene" uniqKey="Jacq Foucher M" first="Marylène" last="Jacq-Foucher">Marylène Jacq-Foucher</name><name sortKey="Labauge, Pierre" sort="Labauge, Pierre" uniqKey="Labauge P" first="Pierre" last="Labauge">Pierre Labauge</name><name sortKey="Laplaud, David Axel" sort="Laplaud, David Axel" uniqKey="Laplaud D" first="David-Axel" last="Laplaud">David-Axel Laplaud</name><name sortKey="Laplaud, David Axel" sort="Laplaud, David Axel" uniqKey="Laplaud D" first="David-Axel" last="Laplaud">David-Axel Laplaud</name><name sortKey="Laplaud, David Axel" sort="Laplaud, David Axel" uniqKey="Laplaud D" first="David-Axel" last="Laplaud">David-Axel Laplaud</name><name sortKey="Laplaud, David Axel" sort="Laplaud, David Axel" uniqKey="Laplaud D" first="David-Axel" last="Laplaud">David-Axel Laplaud</name><name sortKey="Le Frere, Fabienne" sort="Le Frere, Fabienne" uniqKey="Le Frere F" first="Fabienne" last="Le Frere">Fabienne Le Frere</name><name sortKey="Lebrun, Christine" sort="Lebrun, Christine" uniqKey="Lebrun C" first="Christine" last="Lebrun">Christine Lebrun</name><name sortKey="Lepage, Emmanuelle" sort="Lepage, Emmanuelle" uniqKey="Lepage E" first="Emmanuelle" last="Lepage">Emmanuelle Lepage</name><name sortKey="Michel, Laure" sort="Michel, Laure" uniqKey="Michel L" first="Laure" last="Michel">Laure Michel</name><name sortKey="Ouallet, Jean Christophe" sort="Ouallet, Jean Christophe" uniqKey="Ouallet J" first="Jean-Christophe" last="Ouallet">Jean-Christophe Ouallet</name><name sortKey="Pelletier, Jean" sort="Pelletier, Jean" uniqKey="Pelletier J" first="Jean" last="Pelletier">Jean Pelletier</name><name sortKey="Vukusic, Sandra" sort="Vukusic, Sandra" uniqKey="Vukusic S" first="Sandra" last="Vukusic">Sandra Vukusic</name><name sortKey="Wiertlewski, Sandrine" sort="Wiertlewski, Sandrine" uniqKey="Wiertlewski S" first="Sandrine" last="Wiertlewski">Sandrine Wiertlewski</name><name sortKey="Wiertlewski, Sandrine" sort="Wiertlewski, Sandrine" uniqKey="Wiertlewski S" first="Sandrine" last="Wiertlewski">Sandrine Wiertlewski</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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