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Abstract Details

Use of Systemic Hormonal Contraceptives is Associated with Faster Timed 25-foot Walk Speeds in Females with Multiple Sclerosis
Multiple Sclerosis
P11 - Poster Session 11 (8:00 AM-9:00 AM)
1-010
To evaluate the association between use of hormone-containing contraceptives and disability and MRI measures in multiple sclerosis (MS).
The role sex hormones, including estrogen and progesterone, play in the pathophysiology of MS activity is uncertain, with possible contributions to immuno-protection and remyelination. Thalamic volume predicts long term disability, while the timed 25-foot walk (T25-FW) is a functional gait measurement representing lower extremity disability.

This retrospective study included female MS patients ages 18-45 that received both MS care and primary care or OBGYN care at our institution. Contraceptive use was defined as 6 months stable use of 1) systemic hormonal contraception, 2) hormone-containing intrauterine devices (IUDs), or 3) non-users of hormonal contraception. Inclusion required a brain MRI completed as part of routine care within 18 months of contraception periods. T25-FW (included if within 90 days of MRI) was obtained as part of routine MS care.  

Multivariable linear regression models were used to assess the association of contraceptive group with thalamic volume and T25-FW, adjusting for age at MRI, age of MS symptom onset, MS disease course, and disease modifying therapy (DMT) efficacy (high, moderate or low).
1,504 patients were included (age 38 ±6.6 years, 75% White, 73% with RRMS, and 59% on high efficacy DMT). 261 females (17.4%) were using systemic hormonal contraceptives, 56 (3.7%) using IUDs, and 1,187 (78.9%) non-users. Compared to non-users, systemic hormonal contraceptive users performed better in T25-FW [ -0.76s (SE=0.30), p=0.01], while IUD users showed no significant difference [-0.32s (SE=0.62), p=0.6]. There was no significant difference in thalamic volume fraction for systemic hormone or IUD users compared to non-users [–0.01 (SE=0.01), p=0.1 and 0.01 (SE=0.01), p=0.33 respectively].
Systemic hormonal contraception use was associated with better gait speed, but did not affect thalamic volume, suggesting contraception may improve functional performance without a clear protective CNS effect.
Authors/Disclosures
Katherine Havard-Coiro, MD (Cleveland Clinic Foundation)
PRESENTER 		Dr. Havard-Coiro has nothing to disclose.
Marisa P. McGinley, DO (Cleveland Clinic) Dr. McGinley has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley 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. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ. The institution of Dr. McGinley has received research support from EMD Serono.
Kunio Nakamura, PhD (Cleveland Clinic) Dr. Nakamura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for INmune Bio. The institution of Dr. Nakamura has received research support from Biogen. The institution of Dr. Nakamura has received research support from PCORI. The institution of Dr. Nakamura has received research support from NIH. The institution of Dr. Nakamura has received research support from Genzyme. The institution of Dr. Nakamura has received research support from NIH. The institution of Dr. Nakamura has received research support from Genzyme. The institution of Dr. Nakamura has received research support from Novartis. The institution of Dr. Nakamura has received research support from DOD. Dr. Nakamura has received intellectual property interests from a discovery or technology relating to health care.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic) Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
Lindsay Ross, MD (Cleveland Clinic Foundation) Dr. Ross has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapuetics. Dr. Ross has received publishing royalties from a publication relating to health care.