Abstract Details

Title Relapse of Neuromyelitis Optica Associated with Pregnancy Is More Frequently Than That for Multiple Sclerosis

Topic MS and Related Diseases

Presentation(s) P02 - (-)

Poster/Presentation
Number 126

Objective

Background BACKGROUND: Recent reports have described the influence of pregnancy on the clinical course of NMO. This study investigated whether the influence of pregnancy on Japanese NMO patients differs from that in other countries.

Design/Methods DESIGN/METHODS: We retrospectively studied pregnant patients with NMO seen at four cooperative hospitals and diagnosed according to aquaporin (AQP-4) antibody (Ab)-positive findings and its revised criteria. We analyzed the annual relapse rate (ARR) for disease onset and/or relapse associated with pregnancy and investigated the year before pregnancy (BP), each trimester during pregnancy (1st, DP1; 2nd, DP2; 3rd, DP3) and each trimester postpartum (1st, PP1; 2nd, PP2; 3rd, PP3; 4th and over, PP4). We followed AQP-4-Ab titers and Th1/Th2-associated chemokines during pregnancy and postpartum in one patient.

Results RESULTS: All 139 women with NMO were AQP-4-Ab-positive. A total of 47 women were informative 54 pregnancies. Nineteen patients showing NMO relapse in association with pregnancy were identified: 12 women showed NMO onset before pregnancy and seven developed NMO-associated pregnancy. For each period, mean ARR was 0.45 for BP, 0.63 for DP1 and DP2, 0.21 for DP3, 1.89 for PP1, 0.84 for PP2, 0.42 for PP3, and 0.21 for PP4. One patient studied showed gradual increases in AQP-4-Ab titer and CD8+Th1/Th2-associated chemokine ratio during pregnancy, reaching peak values in the postpartum relapse phase.

Conclusions CONCLUSIONS: This study showed that the frequency of Japanese NMO patients exacerbation association with pregnancy is significantly increased during PP1, as reported previously. ARR for NMO during PP1 was much higher than that for MS. Th2-predominance may not be the main pathogenic mechanism underlying exacerbation of NMO during pregnancy.

Authors/Disclosures
Yuko Shimizu, MD, PhD (Tokyo Women'S Medical University School of Medicine) PRESENTER	Dr. Shimizu has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Biogen Japan.. Dr. Shimizu has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis Pharma. Dr. Shimizu has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Chigai Pharma CoLtd.
Alasdair Coles, MD, PhD (University of Cambridge)	Dr. Coles has nothing to disclose.
Takashi Ohashi (Brigham and Women's Hospital)	No disclosure on file
Ichiro Nakashima, MD, PhD (Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital)	Dr. Nakashima 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. Nakashima 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. Nakashima 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. Nakashima has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chugai. Dr. Nakashima has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Nakashima has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Nakashima has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Nakashima has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Chugai. The institution of Dr. Nakashima has received research support from LSI Medience. The institution of Dr. Nakashima has received research support from BML.
	No disclosure on file
Sachiko Kubo	No disclosure on file
	No disclosure on file
Kazumasa Yokoyama, MD	No disclosure on file
Kazuo Fujihara, MD (Tohoku University, School of Medicine)	Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Boipharma. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Japan Tobacco. Dr. Fujihara 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. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Mitsubishi-Tanabe. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chugai/Roche. Dr. Fujihara 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. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Fujihara has received research support from Ministry of Health, Welfare and Labor of Japan. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving as a speaker, chair, etc with Novartis. Dr. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving as a speaker, chair, etc with Biogen. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving as a speaker, chair, etc with Mitsubishi-Tanabe. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving as a apeaker, chair, etc with Chugai/Roche. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a speaker, chair, etc with Alexion. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a chair, speaker with Asahi Kasei Medical. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a speaker with Eisai. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a speaker, chair with Teijin.
	No disclosure on file

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