Frontiers in Neurology (Jan 2022)

Estimating Risk of Multiple Sclerosis Disease Reactivation in Pregnancy and Postpartum: The VIPRiMS Score

  • Gabriel Bsteh,
  • Harald Hegen,
  • Katharina Riedl,
  • Patrick Altmann,
  • Franziska Di Pauli,
  • Rainer Ehling,
  • Gudrun Zulehner,
  • Paulus Rommer,
  • Fritz Leutmezer,
  • Florian Deisenhammer,
  • Thomas Berger

DOI
https://doi.org/10.3389/fneur.2021.766956
Journal volume & issue
Vol. 12

Abstract

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Background:Evidence guiding personalized decision-making with respect to disease-modifying therapy (DMT) around pregnancy in relapsing multiple sclerosis (RMS) is lacking.Objective:To generate and validate a risk score for disease reactivation intrapartum and postpartum in RMS.Methods:From the Vienna Innsbruck MS database (VIMSD), we included 343 pregnancies in patients with RMS. Primary endpoint was disease reactivation. Patients were randomly assigned 2:1 in a generation and validation dataset. A predictive score was calculated using the Cox regression and validated.Results:In the generation dataset, occurrence of relapse and type of DMT in the year before conception, DMT washout duration, the Expanded Disability Status Scale (EDSS) at conception, and time until DMT restart postpartum were identified as independent predictors of disease reactivation (p < 0.001). The resulting 10-point risk score robustly predicted reactivation (explaining 75% of variance, p < 0.001) identifying patients at high [≥6 points; mean risk 65%; range 50–100%; hazard ratio (HR) 14.5], intermediate (3–5 points; mean risk 24%; range 15–35%; HR 4.3), and low risk (≤2 points; mean risk 6%; range 0–8%) of disease reactivation in pregnancy and up to 6 months postpartum.Conclusion:The composite Vienna Innsbruck Pregnancy Risk in Multiple Sclerosis (VIPRiMS) score is a valuable clinical tool to support patients and neurologists in anticipating risk and, thus, individualizing treatment decision-making around pregnancy.

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